Expanding population-level interventions to help more low-income smokers quit

扩大人口干预措施，帮助更多低收入吸烟者戒烟

• 批准号: 10218101
• 负责人: MATTHEW W. KREUTER
• 金额: $ 59.73万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-23 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10218101
• 关键词: Abstinence; Adult; American; Belief; Biochemical; Contracts; Costs and Benefits; Counseling; Data; Economics; Education; Effectiveness; Eligibility Determination; Evidence based practice; Exposure to; Group Homes; Health Care Costs; Home; Hour; Human; Hybrids; Intervention; Lead; Low Income Population; Low income; Measures; Medicaid; Participant; Policies; Population; Poverty; Practical trial; Prevalence; Provider; Psychological Stress; Randomized; Readiness; Reporting; Research; Services; Smoke-free home; Smoker; Smoking; Societies; Subgroup; Telephone; Testing; Tobacco; Treatment Cost; Uninsured; base; cigarette smoke; comparison intervention; cost effectiveness; design; economic cost; environmental tobacco smoke; evidence base; follow-up; home smoking ban; hybrid type 2 design; non-smoker; policy implication; programs; quitline; randomized trial; recruit; service providers; smoking prevalence; smoking-related cancer; treatment services

Abstract There is an urgent need to engage more low-income smokers in activities that lead to quitting. The current standard of practice for population-level tobacco treatment is phone-based cessation counseling delivered by state tobacco quitlines. But quitline services are restricted to smokers who are ready to quit in the next 30 days, a criterion met by only 20-30% of low-income smokers. Thus, current population level tobacco treatment has nothing to offer 70-80% of low-income U.S. smokers. Based on extensive preliminary research by our study team, we assert that offering a pre-cessation intervention – Smoke Free Homes – to low-income smokers who are not yet ready to quit will: (1) engage more smokers in using proven interventions; (2) increase their readiness to quit and quit attempts; (3) reduce the number of cigarettes they smoke per day; and (4) increase cessation. These benefits will accrue in addition to reducing exposure to harmful secondhand smoke for non-smokers in the home. In a Hybrid Type 2 randomized trial, 1,980 low-income smokers from nine states with high smoking prevalence will be recruited from 2-1-1 helplines to receive either current standard practice (Quitline) or expanded services (Quitline + Smoke Free Homes), both delivered by Optum, the largest U.S. quitline service provider. In the latter condition, smokers will be offered cessation counseling first, just like current standard practice, but those who decline will then be offered Smoke Free Homes. At 3-month follow- up, those in the latter condition who accepted quitline services but did not quit will be offered Smoke Free Homes, and those that accepted Smoke Free Homes but did not quit will be offered quitline services. The effectiveness portion of the Hybrid Type 2 design (Aim 1) will use intent-to-treat analyses to compare group differences at 3- and 6-month follow-up in 7- and 30-day point prevalence abstinence with biochemical verification, as well as 24-hour quit attempts and cigarettes smoked per day. The implementation portion of the Hybrid Type 2 design (Aims 2-3) will measure smokers’ acceptance and use of the interventions, as well as cost-effectiveness and cost-benefits of adding Smoke Free Homes to quitline services. With rates of smoking and smoking-related cancers much higher in low-income populations and treatment costs exceeding tens of billions of dollars annually in Medicaid alone, this large-scale practical trial will provide strong evidence with high external validity to answer an important policy question : Will changing the standard practice for population-level treatment of smoking result in increased cessation in low-income populations?

抽象的 迫切需要让更多低收入吸烟者参与戒烟活动。目前的 人口层面烟草治疗的实践标准是由以下机构提供的基于电话的戒烟咨询 国家烟草戒烟热线。但戒烟热线服务仅限于准备在未来 30 年内戒烟的吸烟者 天，只有 20-30% 的低收入吸烟者符合这一标准。因此，目前人口水平的烟草治疗 无法为 70-80% 的美国低收入吸烟者提供任何帮助。基于我们广泛的初步研究 研究团队认为，我们认为向低收入人群提供戒烟前干预措施——无烟之家 尚未准备好戒烟的吸烟者将： (1) 让更多吸烟者使用行之有效的干预措施； (2) 提高他们戒烟的准备度和戒烟尝试； (3)减少每天吸烟的数量；和 (4)增加戒断。除了减少接触有害二手货之外，还会产生这些好处 为家里不吸烟的人吸烟。在一项混合 2 型随机试验中，来自九个州的 1,980 名低收入吸烟者 吸烟率高的州将从 2-1-1 热线招募来接受当前标准 实践（戒烟热线）或扩展服务（戒烟热线 + 无烟之家），均由最大的 Optum 提供 美国戒烟热线服务提供商。在后一种情况下，吸烟者将首先获得戒烟咨询，就像 目前的标准做法，但那些拒绝的人将被提供无烟之家。 3个月后—— 接受戒烟热线服务但未戒烟的后一种情况的人将获得无烟服务 家庭以及接受无烟家庭但未戒烟的家庭将获得戒烟热线服务。这 混合 2 型设计的有效性部分（目标 1）将使用意向治疗分析来比较组 3 个月和 6 个月随访时，7 天和 30 天生化点戒断流行率的差异 验证，以及 24 小时戒烟尝试和每天吸烟的数量。的实施部分 混合类型 2 设计（目标 2-3）将衡量吸烟者对干预措施的接受度和使用情况，以及 将无烟之家添加到戒烟热线服务中的成本效益和成本效益。与吸烟率 低收入人群中与吸烟相关的癌症发病率更高，治疗费用超过数十美元 仅医疗补助每年就耗资数十亿美元，这项大规模的实际试验将为 回答一个重要政策问题的高外部效度：是否会改变标准做法 人群层面的吸烟治疗会导致低收入人群戒烟率增加吗？