Veteran Social Support Intervention for Enhancing Smoking Treatment Utilization and Cessation

背景：加强循证戒烟治疗的获取和使用，消除 与烟草有关的健康差距是国家和退伍军人健康服务的首要优先事项。烟草的流行 与非退伍军人相比，退伍军人的使用量更大。2010-2015年间，29%的女性和21%的男性 退伍军人报告说，他们现在吸烟。循证戒烟疗法(EBCT)，如烟草 戒烟、行为咨询和药物治疗在老吸烟者中被大大地利用不足。差距 继续接触女退伍军人，并利用现有的社会支持网络，加强使用循证护理和 退伍军人中的戒烟 创新和影响：该项目在评估社会支持网络的主动性方面具有创新性 推广方法，以提高戒烟治疗在老烟民中的利用率。社会的作用 建立了网络影响和社会支持对成功戒烟的影响。基于科恩的 社会支持理论，我们的团队为不同的家庭成员，朋友， 以及其他想要帮助吸烟者戒烟的成年人。干预包括书面材料和1-call， 15-25分钟的辅导课程。预计这对可能不会吸烟的资深吸烟者特别有益 否则，请接受停药治疗。因为我们之前的VHA试验招募了94%的男性和更高的 在女性吸烟率方面，我们将对女性进行抽样调查，以获得同等数量的男性和女性 吸烟者。我们的研究有助于退伍军人事务部HSR&D改善治疗机会和 这对妇女的健康具有重要意义，因为它将促进对与退伍军人合作的作用的研究 家庭和/或重要其他人，以增加获得退伍军人管理局医疗保健和针对特定人群的治疗的机会； 尤其是女退伍军人。有效社会支持的潜在覆盖范围和对公共健康的影响 对资深烟草使用者群体的干预是相当大的。 具体目标：(目标1)评估社会支持干预对老年吸烟者使用 EBCT，(目标2)检查对生化确诊的患者进行社会支持干预的有效性 7天吸烟率戒烟，(目标3)探索潜在的调节因素(例如，吸烟者 性别、SP烟草使用状况)干预对研究结果的影响，以及(目标4)进行一个过程 评估社会支持干预措施的实施结果(覆盖范围、采用率、忠诚度) 可能影响执行的多层面因素。 方法：我们将在国家VHA健康范围内进行务实的随机对照试验(RCT) 评估社会支持干预与对照条件的有效性的系统 VHA登记吸烟者中EBCT的使用情况。资深吸烟者，无论准备戒烟的程度如何， 将使用VHA电子健康记录在全国范围内进行识别并主动招募。感兴趣 吸烟者将被要求确定将登记的支持人员(SP)。参赛者将随机分为 吸烟者-SP双联体进入干预组(n=594个双联体)或对照组(n=594个双联体)。所有吸烟者都会 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。服务提供商 分配到干预组的参与者还将获得1次呼叫辅导课程。评估 对于两个研究组中的DYAD，将在基线、3个月和6个月后随机进行。 实施/下一步：下一步取决于实际结果，但我们预计结果会很重要 致退伍军人事务部领导人、退伍军人妇女健康研究联盟和退伍军人社区。我们将保持 在整个项目中与退伍军人管理局计划合作伙伴进行沟通，及时分享调查结果。我们会 与CCDOR的资深参与小组合作开发以患者为中心的传播 未来干预措施调整和/或实施的方法和建议。

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.