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 国际吧尽管近几十年来发达国家的烟草使用有所下降， 在许多低收入和中等收入国家（LMIC），这一比例仍然很高。在老挝人民民主 在老挝共和国，51%的成年男子和7%的成年妇女吸烟。发展和 评估适合在以下国家广泛采用的可持续戒烟干预措施， 老挝人民民主共和国迫切需要公共卫生。为了满足这一需求，我们提出了一个项目， 基于理论和经验的移动的健康（mHealth）技术，帮助人们戒烟 在老挝人民民主共和国。这种移动健康方法包括一个完全自动化的，互动的，个性化的，智能手机- 通过我们的Insight™平台提供行为治疗干预。移动健康干预措施 在发达国家中正在扩散，但在老挝人民民主共和国利用类似方法的努力极其困难。 有限公司世界卫生组织承认，使用移动健康促进健康具有成本效益， 可扩展和可持续，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，烟草负担得起的 全球控制。我们已经开发了移动健康平台和为此提出的干预方法 一项研究和试点测试了这项技术与一组柬埔寨吸烟者。初步结果显示， 我们的移动医疗技术是有效的，高度可行的，适当的，并有可能扩展到LMIC 设置.老挝人民民主共和国的拟议项目包括两个主要阶段。在R21阶段，我们将使用 研究方法，使我们的干预内容适应社会文化背景，语言和沟通 老挝风格在随后的R33阶段，我们将进行随机对照试验（RCT）， 评估我们的移动健康干预措施和技术的有效性。将招募成年吸烟者， 通过两家大医院：万象的Setthathirath医院和占巴塞的占巴塞医院 省受试者（n=500）将被随机分配至2个治疗组之一：标准治疗（SC; n=250）或 自动化治疗（AT; n=250）。SC包括研究人员提供的戒烟简短建议，自我介绍， 帮助书面材料，以及2周的NRT（透皮贴剂）供应。AT由所有SC组件组成 再加上一个全自动的基于智能手机的治疗计划， 主动消息、图像或视频。试验的主要健康结果是生化证实的自我- 研究入组后12个月报告的7天时点戒烟率。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，并维持美国-老挝人民民主共和国研究网络。项目 有可能改变全国戒烟治疗的医疗保健服务， 最终，大幅度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.