An Avatar-Led Web-Based and SMS Text Message Smoking Cessation Program for Socioeconomically Disadvantaged Veterans: Pilot Randomized Controlled Trial.
An Avatar-Led Web-Based and SMS Text Message Smoking Cessation Program for Socioeconomically Disadvantaged Veterans: Pilot Randomized Controlled Trial.
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DOI：
10.2196/44503
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发表时间：
2023-04-14
影响因子：
2.2
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尽管美国的吸烟率下降，但接受退伍军人健康管理局护理的社会经济弱势退伍军人吸烟率很高。目前，这些退伍军人的可用治疗方案集中在准备戒烟且范围有限的烟草使用者身上。因此，非常需要为各级准备戒烟的退伍军人提供方便，有效的戒烟干预措施。为了满足这些需求，我们开发了Vet Quit，一个基于网络的退伍军人接受和承诺治疗计划，并在一项试点随机对照试验中评估了其可接受性（主要目的），疗效和对基于理论的变化过程的影响，相对于美国国家癌症研究所的SmokefreeVET计划。参与者（N=49）以1：1的比例随机接受Vet戒烟（n=25）或SmokefreeVET（n=24）网络计划。两组都收到了短信作为干预的一部分，为期6周。这两种干预措施都是完全自动化和自我指导的。在随机化后3个月收集主要结局数据。使用唾液可替宁对自我报告的戒烟进行生化验证。采用多变量逻辑回归、负二项回归和线性回归模型评价治疗组与关注结局之间的相关性。通过总体治疗满意度测量的可接受性较高，且治疗组间相似：Vet戒烟组为100%（17/17），SmokefreeVET组为95%（18/19）。通过利用率测量的可接受性更适中（登录：Vet戒烟的M=3.7，SmokefreeVET的M=3.2）。治疗组之间的任何可接受性指标均无统计学显著差异。同样，治疗组之间在戒烟或接受和承诺疗法的理论过程变化的次要结局方面也没有统计学显著差异。在开放式调查的答复中，两个治疗组的一些退伍军人表示有兴趣获得专业人士或同行的支持，以提高他们的经验，以及扩大短信短信程序。这两个程序的可接受性，有限的利用率，以及类似的戒烟和戒烟过程的影响。结合定性数据表明，额外的支持可能会增强参与者对这两个项目的体验，这些初步研究结果表明，这些项目可能会在正在寻找数字戒烟治疗方案的退伍军人中产生类似的结果，并且整合提供者或同行支持并增强SMS短信程序有望作为提高参与度和结果的一种手段。ClinicalTrials.gov NCT 04502524; https://clinicaltrials.gov/ct2/show/NCT04502524
Despite the declining prevalence of cigarette smoking in the United States, socioeconomically disadvantaged veterans receiving care from the Veterans Health Administration have a high prevalence of smoking. Currently, available treatment options for these veterans focus on tobacco users who are ready to quit and have limited reach. Consequently, there is a great need for accessible, effective smoking cessation interventions for veterans at all levels of readiness to quit smoking. To address these needs, we developed Vet Flexiquit, a web-based Acceptance and Commitment Therapy program for veterans, and evaluated its acceptability (primary aim), efficacy, and impact on theory-based change processes relative to the National Cancer Institute’s SmokefreeVET program in a pilot randomized controlled trial. Participants (N=49) were randomized 1:1 to receive either the Vet Flexiquit (n=25) or SmokefreeVET (n=24) web program. Both groups received SMS text messages as part of the intervention for 6 weeks. Both interventions are fully automated and self-guided. Primary outcome data were collected at 3 months after the randomization. Self-reported smoking abstinence was biochemically verified using saliva cotinine. Multivariable logistic regression, negative binomial regression, and linear regression models were used to evaluate the association between the treatment arm and outcomes of interest. Acceptability, as measured by overall treatment satisfaction, was high and similar across treatment arms: 100% (17/17) for Vet Flexiquit and 95% (18/19) for SmokefreeVET. Acceptability, as measured by utilization, was more modest (log-ins: M=3.7 for Vet Flexiquit and M=3.2 for SmokefreeVET). There were no statistically significant differences between treatment arms for any acceptability measures. Similarly, there were no statistically significant differences between treatment arms in the secondary outcomes of smoking cessation or change in Acceptance and Commitment Therapy’s theory-based processes. In open-ended survey responses, some veterans in both treatment arms expressed interest in having support from a professional or peer to enhance their experience, as well as an expanded SMS text messaging program. Both programs had high ratings of acceptability, limited utilization, and a similar impact on cessation and cessation processes. Taken together with the qualitative data suggesting that additional support may enhance participants’ experience of both programs, these preliminary findings suggest that the programs may have similar outcomes among veterans who are looking for a digital cessation treatment option and that integrating provider or peer support and enhancing the SMS text messaging program holds promise as a means of boosting engagement and outcomes for both programs. ClinicalTrials.gov NCT04502524; https://clinicaltrials.gov/ct2/show/NCT04502524