A home-based behavioral treatment for cigarette smoking

描述（由申请人提供）： 吸烟是发达国家发病率和死亡率的最大可预防风险因素。尽管越来越多的药物和心理治疗吸烟，超过20%的美国人继续吸烟。目前干预措施的局限性表明需要创新和强大的吸烟行为疗法。禁欲强化疗法就是这样一种治疗方法。为了将戒烟强化疗法应用于吸烟，我们开发了一个以家庭为基础的监测系统，以获得吸烟状况的客观指标。该系统利用互联网技术获取吸烟者提供一氧化碳样本的视频，这是一种简单而创新的方法，可以经常和持续地核实吸烟状况。强化戒烟可显著减少重度吸烟者的吸烟和持续戒烟。鉴于这些令人鼓舞的数据，我们建议在一项为期三年的研究中复制和扩展我们目前的结果。基于家庭的系统将允许我们在戒烟尝试的最初几周提供高剂量的行为治疗。这是一个关键时期：在戒烟努力的最初几周内戒烟与长期成功密切相关，大多数吸烟者在戒烟尝试的第一周内复发。此外，最近的几项研究表明，用代金券强化实验性地诱导戒烟，即使对没有戒烟计划的吸烟者来说，也会产生更大的戒烟动机和持久的效果。强化治疗还降低了与复发风险相关的一些关键指标的评分。这些实验诱导的动机和复发风险的变化是否真的转化为较低的复发率，还有待观察。重度吸烟者将被随机分配到代金券强化或非应急代金券强化控制条件。我们将测量戒烟动机、复发风险、治疗期间的初始戒烟率以及6个月随访时的吸烟状况。这项拟议的研究将是第一个提供有价值的数据，说明在重度吸烟者中复发风险和复发率的关键指标中券引起的变化之间的关系，以及在戒烟尝试的关键时期应用强化行为治疗的有效性。以家庭为基础的代金券计划可能被证明是启动和维持高水平禁欲的严格和方便的方法，特别是在高风险群体中。因此，作为降低与吸烟相关的高发病率和死亡率的一种方式，它可能具有重大的前景。

DESCRIPTION (provided by applicant): Cigarette smoking is the largest preventable risk factor for morbidity and mortality in developed countries. Despite an increasing number of pharmacological and psychosocial treatments for smoking, over 20% of Americans continue to smoke. The limitations of current interventions point to the need for innovative and powerful behavioral therapies for smoking. Abstinence reinforcement therapy is one such treatment. To apply abstinence reinforcement therapy to smoking, we developed a home-based monitoring system to obtain objective measures of smoking status. The system uses Internet technology to obtain video of smokers providing carbon monoxide samples, which is a simple yet innovative way to verify smoking status on a frequent and sustained basis. Voucher reinforcement produced substantial reductions in smoking and sustained abstinence in heavy smokers. In light of these encouraging data, we are proposing to replicate and extend our current results in a three-year study. The home-based system will allow us to deliver a high dose behavioral treatment during the initial weeks of a quit attempt. This is a critical period: abstinence during the first few weeks of a cessation effort is strongly associated with long-term success, and most smokers relapse within the first week of a quit attempt. Furthermore, several recent studies suggest that experimentally inducing abstinence with voucher reinforcement produces increased motivation to quit and lasting effects, even for smokers with no plans to quit. Voucher reinforcement also lowers ratings on a number of key measures associated with relapse risk. It remains to be seen whether these experimentally induced changes in motivation and relapse risk do, in fact, translate into lower relapse rates. Heavy smokers will be randomly assigned to a voucher reinforcement or a non-contingent voucher reinforcement control condition. We will measure motivation to quit, relapse risk, rates of initial abstinence during treatment, and smoking status at a six-month follow up. The proposed study will be the first to provide valuable data about the relation between voucher-induced changes in key measures of relapse risk and relapse rates in heavy smokers, and the efficacy of applying an intensive behavioral treatment during a critical period of a quit attempt. The home-based voucher program may prove to be rigorous and convenient method to initiate and maintain high levels of abstinence, particularly in high-risk groups. As such, it may hold significant promise as a way to reduce the high rates of morbidity and mortality associated with smoking.