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导致戒烟的活动。海流 人群水平烟草治疗的实践标准是由以下机构提供的电话戒烟咨询 州烟草公司的戒烟热线。但戒烟服务仅限于准备在未来30年内戒烟的吸烟者。 天数，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 没有为70%-80%的美国低收入吸烟者提供任何东西。基于我们的广泛的初步研究 研究小组，我们断言，为低收入者提供戒烟前干预措施-无烟家庭- 尚未准备戒烟的吸烟者将：(1)吸引更多吸烟者使用行之有效的干预措施；(2) 增加他们戒烟和戒烟的意愿；。(3)减少他们每天吸烟的次数；及。 (4)加大停产力度。除了减少接触有害的二手烟外，这些好处还将增加 在家中为非吸烟者吸烟。在一项混合型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帮助热线中招募，以获得目前的标准 Practice(Quitline)或扩展服务(Quitline+无烟家庭)，均由最大的Optom提供 美国离线服务提供商。在后一种情况下，吸烟者将首先得到戒烟咨询，就像 目前的标准做法，但那些拒绝的人将被提供无烟房屋。在3个月后- 在后一种情况下，接受戒烟服务但没有戒烟的人将被提供无烟服务 住房，以及那些接受无烟住房但没有退出的人将被提供戒烟服务。这个 混合类型2设计(目标1)的有效性部分将使用意向治疗分析来比较组 生化戒断7天和30天时点戒断率在3个月和6个月随访中的差异 验证，以及24小时戒烟尝试和每天吸烟。计划的实施部分 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和使用，以及 在戒烟服务中增加无烟家庭的成本效益和成本效益。与吸烟率 与吸烟相关的癌症在低收入人群中要高得多，治疗费用超过 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 高外部效度回答了一个重要的政策问题：是否会改变 人群水平的吸烟治疗导致低收入人群戒烟增加吗？

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?