Mobile Health Technology for Personalized Tobacco Cessation Support in Laos

项目摘要：烟草使用仍然是可预防的发病率和死亡率的主要原因 全世界。尽管近几十年来发达国家的烟草使用量有所下降，但吸烟的流行率 在许多低收入和中等收入国家(LMIC)，这一比例仍然高得惊人。在老挝人民民主中 在老挝人民民主共和国，51%的成年男子和7%的成年妇女吸烟。中国的发展和 对适合在以下国家广泛采用的可持续戒烟干预措施进行评估 老挝人民民主共和国迫切需要公共卫生。为了解决这一需求，我们提出了一个项目，以适应我们的 基于理论和经验的移动健康(MHealth)技术，帮助人们戒烟 在老挝人民民主共和国。这种mHealth方法包括一款完全自动化、交互式、个性化的智能手机- 通过我们的洞察™平台提供针对行为治疗的干预。移动健康干预措施 在发达国家正在激增，但在老挝人民民主共和国利用类似方法的努力非常 有限的。世界卫生组织承认，使用移动健康促进健康是具有成本效益的， 可扩展、可持续，包括对最不发达国家。此外，短信 戒烟干预措施已被证明是有效的，成本效益高的，而且对烟草来说负担得起。 在全球范围内控制。我们已经开发了移动健康平台和为此提出的干预方法 研究和试点测试了一组柬埔寨吸烟者的这项技术。初步结果显示 我们的mHealth技术是有效的、高度可行的、适用于LMIC的，并且具有潜在的可扩展性 设置。老挝人民民主共和国的这一拟议项目包括两个主要阶段。在R21阶段，我们将使用形成性 使干预内容适应社会文化背景、语言和交际的研究方法 老挝人的风格。在随后的R33阶段，我们将进行随机对照试验(RCT)，以 评估我们的移动健康干预和技术的有效性。成年吸烟者无论男女都将被招募 通过两家大医院：万象的Setthatherath医院和Champasak的Champasak医院 省。参与者(n=500)将被随机分为两个治疗组之一：标准护理(SC；n=250)或 自动治疗(AT；n=250)。SC由研究人员提供的简短戒烟建议组成，自我 帮助编写材料，并提供2周的NRT(透皮贴片)。AT由所有SC组件组成 外加基于智能手机的全自动治疗程序，涉及交互式和个性化 积极主动的消息、图像或视频。该试验的主要健康结果是经过生化证实的自我 在研究登记后12个月，报告的7天点戒断率。该项目还旨在 提高老挝人民民主共和国的移动卫生研究能力，支持美国-老挝人民民主共和国的研究网络。该项目 有可能改变全国戒烟治疗的医疗服务， 最终，大幅降低烟草引起的发病率和死亡率。

PROJECT SUMMARY: Tobacco use remains the leading cause of preventable morbidity and mortality worldwide. Although tobacco use has declined in developed nations in recent decades, smoking prevalence remains strikingly high in many low- and middle-income countries (LMICs). In Lao People's Democratic Republic (Lao PDR), 51% of adult men and 7% of adult women smoke tobacco. The development and evaluation of sustainable tobacco cessation interventions suitable for widespread adoption in nations such as Lao PDR are pressing public health needs. To address this need, we propose a project that adapts our theoretically and empirically based mobile health (mHealth) technology to help people quit smoking cigarettes in Lao PDR. This mHealth approach includes a fully automated, interactive, personalized, smartphone- delivered intervention for behavioral treatment, delivered through our Insight™ platform. mHealth interventions are proliferating in developed countries, but efforts to utilize similar approaches in Lao PDR are extremely limited. The World Health Organization acknowledges that using mHealth for health promotion is cost-effective, scalable, and sustainable, including for the least-developed countries. Additionally, text-messaging interventions for smoking cessation have been shown to be effective, cost-effective, and affordable for tobacco control globally. We have already developed the mHealth platform and intervention approach proposed for this study and pilot tested this technology with a group of Cambodian smokers. Preliminary results demonstrated that our mHealth technology is efficacious, highly feasible, appropriate, and potentially scalable for LMIC settings. This proposed project for Lao PDR includes 2 main phases. In the R21 Phase, we will use formative research methods to adapt our intervention content to the sociocultural context, language, and communication styles of Laotians. In the subsequent R33 Phase, we will conduct a randomized controlled trial (RCT) to evaluate the efficacy of our mHealth intervention and technology. Adult smokers of both sexes will be recruited through 2 large hospitals: Setthathirath Hospital in Vientiane and Champasak Hospital in Champasak Province. Participants (n=500) will be randomized to 1 of 2 treatment groups: Standard Care (SC; n=250) or Automated Treatment (AT; n=250). SC consists of brief advice to quit smoking delivered by research staff, self- help written materials, and a 2-week supply of NRT (transdermal patches). AT consists of all SC components plus a fully automated smartphone-based treatment program that involves interactive and personalized proactive messages, images, or videos. The primary health outcome of the trial is biochemically confirmed self- reported 7-day point prevalence abstinence 12 months post study enrollment. The project also aims to advance mHealth research capacity in Lao PDR and sustain the US-Lao PDR research network. The project has the potential to transform healthcare services for tobacco cessation treatment throughout the country and, ultimately, to significantly reduce tobacco-induced morbidity and mortality.