ORCID

https://orcid.org/0000-0001-5288-2111

Keywords

attrition, perceived research burden, delay discounting, smoking cessation, repetitive transcranial magnetic stimulation, cancer

Abstract

This secondary analysis examined predictors of attrition in a randomized clinical trial conducted by Roswell Park Comprehensive Cancer Center evaluating repetitive transcranial magnetic stimulation (rTMS) for cigarette smoking cessation. Smoking cessation reduces cancer risk and mortality and improves mental health outcomes. Although rTMS shows promise for supporting sustained abstinence by targeting neurobiological mechanisms underlying nicotine dependence, participant attrition threatens statistical validity, reduces power, and limits generalizability. Identifying predictors of attrition is therefore critical for optimizing trial design and retention.

Research examining predictors of attrition in smoking cessation trials remains limited. Prior work in other clinical populations suggests that higher perceived research burden, participants’ subjective appraisal of logistical, psychological, and physical demands, is associated with increased attrition. Theory further suggests that delay discounting, a preference for immediate over delayed rewards, may amplify this burden by reducing tolerance for participation demands when benefits are delayed.

The present study evaluated the association between perceived research burden and attrition and whether delay discounting moderated this relationship, controlling for demographic and clinical covariates. Data from 260 participants were analyzed using multivariable logistic regression and Cox proportional hazards models, with Kaplan–Meier curves providing descriptive survival patterns. Higher perceived research burden was significantly associated with increased odds and greater hazard of attrition. Delay discounting did not moderate the relationship and was not independently associated with attrition.

Perceived research burden emerged as an independent predictor of attrition. Reducing perceived burden may improve retention, strengthen evaluation of rTMS, and support smoking cessation to reduce cancer-related morbidity and mortality.

Completion Date

2026

Semester

Spring

Committee Chair

Jeffrey E. Cassisi

Degree

Doctor of Philosophy (Ph.D.)

College

College of Sciences

Department

Psychology

Format

PDF

Document Type

Dissertation

Identifier

DP0053151

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