Veteran Social Support Intervention for Enhancing Smoking Treatment Utilization and Cessation

背景：加强循证戒烟治疗的获得和使用， 烟草相关的健康差距是国家和弗吉尼亚州卫生服务的首要任务。烟草的流行 与非退伍军人相比，退伍军人的使用率更高。2010-2015年，29%的女性和21%的男性 退伍军人报告目前吸烟。循证戒烟治疗（EBCT），如烟草 戒烟热线，行为咨询和药物治疗，是非常利用退伍军人吸烟者。差距 继续接触女退伍军人，并利用现有的社会支助网络，加强对EBCT的利用， 退伍军人之间的停止 创新和影响：这个项目是创新的评估社会支持网络作为一个积极的 外展方法，以提高戒烟治疗的使用退伍军人吸烟者。社会的作用 网络影响和社会支持对戒烟成功的影响。根据科恩的 社会支持理论，我们的团队开发了一种社会支持干预，适用于不同的家庭成员，朋友， 和其他想帮助吸烟者戒烟的成年人。干预包括书面材料和一个电话， 15-25分钟的辅导课程。它预计将特别有利于退伍军人吸烟者谁可能不会 否则可获得戒烟治疗。因为我们之前的VHA试验招募了大约94%的男性， 为了提高女性吸烟率，我们将对女性进行过度抽样，以招募相同数量的男性和女性 吸烟者。我们的研究有助于VA HSR&D的优先计划，以提高治疗的可及性， 妇女的健康，是重要的，因为它将推进研究的作用，与退伍军人的合作， 家庭和/或重要的其他人，以提高获得VA医疗保健和人口特定的治疗， 尤其是女性退伍军人。有效社会支持的潜在覆盖范围和公共卫生影响 对退伍军人烟草使用者群体的干预是相当大的。 具体目的：（目的1）评价社会支持干预对老年吸烟者使用 EBCT，（目的2）探讨社会支持干预对经生化检查确诊的精神分裂症患者的有效性 7-日点患病率吸烟戒烟，（目的3）为了探索潜在的调节因子（例如，吸烟者 性别，SP烟草使用状况）对研究结果的干预效果，以及（目的4）进行一个过程 评估社会支持干预措施的执行成果（覆盖面、采用率、忠诚度），以及 可能影响实施的多层次因素。 方法：我们将在国家VHA健康范围内进行一项实用的随机对照试验（RCT）。 一个系统，以评估社会支持干预的有效性与控制条件相比， VHA登记的吸烟者使用EBCT。资深吸烟者，无论戒烟的准备程度如何， 将使用VHA电子健康记录在全国范围内识别并积极招募。兴趣 吸烟者将被要求确定一个支持人员（SP）谁将登记。受试者将随机分配， 吸烟者-SP二分体与干预（n= 594二分体）或对照条件（n= 594二分体）的比较。所有吸烟者都将 接收有关EBCT的书面资源和信息。所有SP参与者都将收到书面材料。SP 被分配到干预组的参与者将额外接受一次电话辅导。评估 将在基线、随机化后3个月和6个月时对两个研究组中的二联体进行评估。 实施/后续步骤：后续步骤取决于实际结果，但我们预计调查结果很重要 退伍军人管理局领导人，退伍军人管理局妇女健康研究联盟和退伍军人社区。我们将保持 在整个项目中与VA计划合作伙伴进行沟通，及时分享调查结果。我们将 与CCDOR的退伍军人参与小组合作，发展以患者为中心的传播 为今后的干预措施调整和/或实施提出办法和建议。

Background: Enhancing access and use of evidence-based tobacco cessation treatments and eliminating tobacco-related health disparities are top national and VA health services priorities. The prevalence of tobacco use is greater among Veterans compared to non-Veterans. From 2010-2015, 29% of women and 21% of male Veterans reported current cigarette smoking. Evidence-based cessation treatments (EBCTs) such as, tobacco quitlines, behavioral counseling, and pharmacotherapy, are greatly underutilized by Veteran smokers. Gaps remain in reaching women Veterans and use of existing social support networks to enhance use of EBCTs and cessation among Veterans Innovation and Impact: This project is innovative for evaluating social support networks as a proactive outreach approach to enhance cessation treatment utilization among Veteran smokers. The role of social network influences and social support on successful smoking cessation is established. Based on Cohen’s theory of social support, our team developed a social support intervention for diverse family members, friends, and other adults who wanted to help a smoker quit. The intervention consists of written materials and a 1-call, 15-25 minute coaching session. It is expected to be especially beneficial for Veteran smokers who might not otherwise access cessation treatment. Because our prior VHA trials enrolled about 94% men and the higher smoking rates among women, we will oversample women to enroll an equal number of men and women smokers. Our study contributes to VA HSR&D’s priority initiatives for enhancing treatment access and women’s health and is significant because it will advance research on the role of partnering with Veterans’ families and/or important others to enhance access to VA healthcare and population-specific treatments, especially women Veterans. The potential reach and public health impact of an effective social support intervention for the Veteran tobacco user population is considerable. Specific Aims: (Aim 1) To evaluate the impact of the social support intervention on Veteran smokers’ use of EBCT, (Aim 2) To examine the effectiveness of the social support intervention on the biochemically confirmed 7-day point prevalence cigarette smoking abstinence, (Aim 3) To explore potential moderators (e.g., smoker gender, SP tobacco use status) of intervention effects on study outcomes, and (Aim 4) To conduct a process evaluation assessing implementation outcomes (reach, adoption, fidelity) of the social support intervention and multilevel factors that may influence implementation. Methodology: We will conduct a pragmatic randomized controlled trial (RCT) within the national VHA health system to evaluate the effectiveness of a social support intervention compared with a control condition on utilization of EBCT among VHA-enrolled smokers. Veteran smokers, regardless of level of readiness to quit, will be identified nationally using the VHA electronic health record and proactively recruited. Interested smokers will be asked to identify a support person (SP) who will enroll. Participants will be randomized as smoker-SP dyads to the intervention (n= 594 dyads) or control condition (n= 594 dyads). All smokers will receive written resources and information on EBCTs. All SP participants will receive written materials. SP participants assigned to the intervention group will additionally receive a 1-call coaching session. Assessments for dyads in both study groups will be conducted at baseline, 3-, and 6-months post-randomization. Implementation/Next Steps: Next steps depend on the actual results, but we expect findings to be important to VA leaders, the VA Women’s Health Research Consortium and the Veteran community. We will maintain communication throughout the project with VA program partners to share findings in a timely manner. We will collaborate with CCDOR’s Veteran Engagement Panel on development of patient-centered dissemination approaches and recommendations for future intervention adaptations and/or implementation.