RE-AIM Evaluation of Tailored Smoking Harm Reduction

描述（由申请人提供）：本修订提案将解决现有计划的几个限制，以帮助住院吸烟者，包括范围和出口。我们将使用RE-AIM评估模型来研究一种创新的干预措施，以接触并涉及即将在科罗拉多州凯撒永久医院接受门诊手术或侵入性内窥镜医疗程序（乙状结肠镜/结肠镜）的吸烟者，但他们拒绝参加戒烟活动。根据初步工作和以前对吸烟者进行减少危害干预的经验，我们将提供一个减少危害计划，其目标是帮助吸烟者将每日卷烟摄入量减少2/3。基于理论的干预将包括目标设定和频繁反馈，基于障碍的解决问题，以及针对吸烟者及其社会环境的其他社会认知程序。它将在手术前（或内镜手术）和手术后通过电话咨询和定制邮件的组合提供，类似于戒烟计划（项目1），作为交互式RO1应用程序的一部分。我们实验室和其他研究人员之前的工作表明，吸烟数量减少50- 75%是可以实现的，而且可以通过一种不导致代偿性吸烟的方式来实现，这样就可以实现并保持生物化学暴露的减少。经过一年的开发工作，我们将对340名吸烟者进行随机试验，将减少危害计划与接收普通邮件的对照条件进行比较。按照RE-AIM模式，项目的主要成果将是1)Reach（参与该计划的吸烟者的百分比和代表性）；2)有效性：随访3个月时，香烟数量、可替宁和一氧化碳水平均有所下降；3)采用率：参与该计划的医生的百分比；4)实施：接受和使用每个干预组件的参与者的百分比；5)维持：戒烟率，减少香烟数量和唾液可替宁，以及一年随访时的CO水平。这是使用互动研究计划资助机制提交的两个项目之一。将对与传播和经济成果有关的再环境目标的各个方面进行跨项目分析。综上所述，这两个项目将为服务不足的人群（住院患者）提供一个重要的综合方案测试，该方案承认戒烟和减少危害是互补的战略。

DESCRIPTION (provided by applicant): This revised proposal will address several limitations of existing programs to help hospitalized smokers, including reach and exportability. We will use the RE-AIM evaluation model to investigate an innovative intervention for reaching and involving smokers about to have out-patient surgery or an invasive endoscopic medical procedure (sigmoidoscopy/colonoscopy) in Kaiser Permanente-Colorado, but who decline to participate in cessation-based smoking activities. Based upon preliminary work and previous experience with harm reduction interventions with smokers, we will offer a harm reduction program with the goal of helping smokers achieve a 2/3 reduction in daily cigarette intake. The theory-based intervention will include goal setting and frequent feedback, barriers-based problem-solving, and other social-cognitive procedures tailored to the smoker and his or her social environment. It will be delivered both before surgery (or endoscopic procedures) and after, by a combination of phone counseling and tailored mailings, similar to that of the smoking cessation program (Project 1) proposed as part of this Interactive RO1 application. Previous work in our lab and by other investigators indicates that 50-75 percent reduction in number of cigarettes smoked is achievable and can be done in a way that does not result in compensatory smoking, so that reductions in biochemical exposures are achieved and maintained.Following a year of developmental work, we will conduct a randomized trial with 340 smokers to compare the harm reduction program to a control condition that will receive generic mailings. Following the RE-AIM model, key outcomes of the project will be 1) Reach (percent and representativeness of smokers who participate in this program); 2) Effectiveness: reductions in number of cigarettes, cotinine, and CO levels at 3 months follow-up; 3) Adoption: the percent of physicians who participate in the program; 4) Implementation: the percent of participants who receive and use each of several intervention components; and 5) Maintenance: the cessation rate, reduction in number of cigarettes and saliva cotinine, and CO levels at one-year follow-up.This is one of two projects being submitted using the Interactive Research Project Grant funding mechanism. Crossproject analyses will be conducted on various RE-AIM dimensions related to dissemination and economic outcomes. Taken together, both projects will provide an important test of an integrated program for an underserved population (patients in the hospital setting) that recognizes cessation and harm reduction as complementary strategies.