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

摘要 迫切需要让更多的低收入吸烟者参与戒烟活动。当前 人口水平烟草治疗的实践标准是通过电话提供戒烟咨询， 州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 只有20-30%的低收入吸烟者符合这一标准。因此，目前的人口水平烟草治疗 没有什么可以提供70-80%的美国低收入吸烟者。根据我们广泛的初步研究， 研究小组，我们断言，提供戒烟前的干预-无烟家园-低收入 还没有准备好戒烟的吸烟者将：（1）让更多的吸烟者使用经证实的干预措施;（2） 增加他们戒烟的意愿和尝试;（3）减少他们每天吸烟的数量;以及 (4)增加停止。除了减少接触有害的二手产品外， 不吸烟的人在家里吸烟。在一项混合2型随机试验中，来自9个国家的1，980名低收入吸烟者 吸烟率高的州将从2-1-1队列中招募，接受现行标准 实践（戒烟热线）或扩展服务（戒烟热线+无烟之家），两者都由Optum提供，Optum是世界上最大的 美国退出线服务提供商。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，但那些拒绝的人将获得无烟之家。在3个月随访时- 在后一种情况下，那些接受戒烟热线服务但没有戒烟的人将被提供无烟服务 家庭，以及那些接受无烟家庭，但没有退出将提供戒烟服务。的 混合2型设计的有效性部分（目标1）将使用意向治疗分析比较组 在3个月和6个月随访时，7天和30天的点戒烟率与生化指标的差异 验证，以及24小时戒烟尝试和每天吸烟。的实现部分 混合型2设计（目标2-3）将衡量吸烟者对干预措施的接受和使用，以及 在戒烟热线服务中增加无烟之家的成本效益和成本效益。随着吸烟率 与吸烟有关的癌症在低收入人群中要高得多， 每年仅医疗补助就有数十亿美元，这项大规模的实际试验将提供强有力的证据， 高外部效度回答一个重要的政策问题：改变标准做法， 在低收入人群中进行人口水平的吸烟治疗会增加戒烟率吗？

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?