Partnering with a State Food Bank to Provide Tobacco Treatment to Underserved Smokers

摘要 用有限的资源有效地将服务不足的吸烟者与有效的戒烟治疗联系起来 对于疾病预防和消除健康差距来说，易于获取的信息是至关重要的。本研究 寻求通过与大型社会服务网络合作来满足这一需求，以评估疗效和 基于理论、全自动、基于智能手机的交互式戒烟的经济影响 干预。俄克拉荷马州地区食品银行(RFBO)是该州最大的饥饿救济慈善机构， 通过由14个食品和资源中心(FRC)组成的网络，向13.6万多名粮食不安全的人提供食物 每周有53个县的客户。我们的初步数据表明，目前吸烟的流行率 在成年客户中的患病率为46%(是美国总人口患病率的3倍多)。参与者 (n=500)将被随机分为两种治疗条件之一：1)标准治疗(ST；n=250)或 自动治疗(AT；n=250)。ST参与者将以电子方式连接到俄克拉荷马烟草公司 帮助热线使用基于平板电脑的门户网站，该门户网站专用于这项研究。此方法旨在镜像 Ask Adise Connect(AAC)方法将医疗保健系统中的吸烟者与戒烟治疗联系起来，我们的 团队之前已经开发和评估过。ST将根据AT进行评估，AT是一种全自动治疗 招生和交付方式。在AT条件下，参与者将收到一部交互式智能手机- 基于干预，包括通过音频/视频剪辑提供的内容和交互式文本内容。大部分 斯蒂芬森癌症公司已经完成了AT的规划和开发工作 中心的移动健康共享资源，以及一系列试点研究(包括在 与RFBO网站的合作)与移动应用程序的测试版是非常令人鼓舞的。 将向所有参与者提供经皮贴片形式的尼古丁替代疗法(NRT)(ST 和AT)。我们这个项目的总体目标是确定AT是否比资源更密集的 ST进近。如果建立了有效性，AT方法将很容易扩展，并可以通过以下方式轻松实现 以社区为基础的组织，并提供一种将有限的公共卫生资源分配给 烟草控制干预措施。主要目的是评估AT和ST在促进戒断方面的疗效 因为吸烟。据推测，在12个月的随访评估中，7天点吸烟率 与ST相比，AT的禁酒率更高。次要目标是：1)比较 通过常见机制(即动机、代理和压力/负面影响)对吸烟产生的中介效应 AT和ST治疗组之间的戒断；以及2)进行经济评估以评估成本 和/或AT与ST的成本效益。迫切需要以理论为基础、具有成本效益和 具有广泛传播潜力的可持续戒烟治疗，AT干预已被 旨在帮助满足这一需求。

SUMMARY Efficiently connecting underserved smokers with limited resources to efficacious tobacco cessation treatments that are easily accessible is crucial for disease prevention and the elimination of health disparities. This study seeks to address this need through partnering with a large social service network to evaluate the efficacy and economic impact of a theoretically-based, fully automated, interactive smartphone-based smoking cessation intervention. The Regional Food Bank of Oklahoma (RFBO) is the largest hunger-relief charity in the state, and through a network of 14 Food and Resource Centers (FRC), provides food to more than 136,000 food insecure clients each week across 53 counties. Our preliminary data indicate that the prevalence of current smoking among adult clients is 46% (more than 3 times the prevalence in the general US population). Participants (n=500) will be randomized to one of two treatment conditions: 1) Standard Treatment (ST; n=250) or Automated Treatment (AT; n=250). ST participants will be electronically connected to the Oklahoma Tobacco Helpline using a tablet-based web portal that is specific to this study. This approach is designed to mirror the Ask Advise Connect (AAC) approach to linking smokers in healthcare systems with quitline treatment that our team has previously developed and evaluated. ST will be evaluated against AT, a fully automated treatment enrollment and delivery approach. In the AT condition, participants will receive an interactive smartphone- based intervention that comprises content delivered via audio/video clips and interactive text content. Much of the programming and developmental work for AT has already been completed by the Stephenson Cancer Center's mHealth Shared Resource, and results from a series of pilot studies (including work conducted in partnership with the RFBO sites) with beta versions of the mobile application are extremely encouraging. Nicotine replacement therapy (NRT) in the form of transdermal patches will be provided to all participants (ST and AT). Our overall goal of this project is to determine if AT performs better than the more resource intensive ST approach. If efficacy is established, the AT approach will be readily scalable, easily implemented by community-based organizations, and offer an efficient way to allocate limited public health resources to tobacco control interventions. The primary aim is to evaluate the efficacy of AT and ST in facilitating abstinence from smoking. It is hypothesized that at the 12-month follow-up assessment, 7-day point prevalence smoking abstinence rates will be higher in AT compared to ST. Secondary aims are to: 1) Compare the magnitude of the mediated effects via common mechanisms (i.e., motivation, agency, and stress/negative affect) on smoking abstinence between the AT and ST treatment groups; and 2) Conduct economic evaluations to assess the cost and/or cost-effectiveness of AT vs. ST. There is a critical need for theoretically-based, cost-effective, and sustainable cessation treatments that have broad dissemination potential, and the AT intervention has been designed to help fill this need.