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

总结 有效地将资源有限的服务不足的吸烟者与有效的戒烟治疗联系起来 容易获得的医疗服务对于预防疾病和消除健康差距至关重要。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， 基于理论的、全自动的、交互式的智能手机戒烟的经济影响 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14个粮食和资源中心（FRC）的网络，为136，000多名粮食不安全的人提供粮食。 每周有53个县的客户。我们的初步数据表明，目前吸烟的流行程度 在成年客户中，这一比例为46%（是美国普通人群患病率的3倍多）。参与者 （n=500）将被随机分配到两种治疗条件之一：1）标准治疗（ST; n=250）或 自动化治疗（AT; n=250）。ST参与者将通过电子方式连接到俄克拉荷马州烟草公司 使用专门针对本研究的基于平板电脑的门户网站的帮助热线。这种方法旨在反映 Ask Advise 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， 团队已经开发和评估。ST将根据AT（一种全自动治疗）进行评估 注册和交付方法。在AT条件下，参与者将获得一个互动智能手机- 包括通过音频/视频剪辑和交互式文本内容传递的内容的基于干预的系统。大部分 斯蒂芬森癌症研究所已经完成了AT的规划和开发工作 中心的mHealth共享资源，以及一系列试点研究的结果（包括在 与RFBO网站的合作伙伴关系）与移动的应用程序的测试版是非常令人鼓舞的。 将以透皮贴剂的形式向所有受试者提供尼古丁替代疗法（NRT）（ST 和AT）。我们这个项目的总体目标是确定AT的性能是否优于资源密集型 ST方法。如果确定了有效性，AT方法将易于扩展，易于实施， 以社区为基础的组织，并提供一种有效的方式分配有限的公共卫生资源， 烟草控制措施。主要目的是评估AT和ST在促进禁欲方面的疗效 从吸烟。假设在12个月的随访评估中，7天时点吸烟率 与ST相比，AT的禁欲率更高。次要目的是：1）比较 经由共同机制的介导效应（即，动机，代理和压力/负面影响）对吸烟的影响 AT和ST治疗组之间的禁欲率;以及2）进行经济评估以评估成本 和/或成本效益的AT与ST。有一个关键的需要，以理论为基础的，成本效益高， 具有广泛传播潜力的可持续戒烟治疗，AT干预已被 旨在满足这一需求。

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.