Comparing Population Cessation Services with Emphasis on Unmotivated Smokers

比较以无动机吸烟者为重点的人口戒烟服务

• 批准号: 7756674
• 负责人: James O Prochaska
• 金额: $ 62.51万
• 依托单位: UNIVERSITY OF RHODE ISLAND
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-15 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7756674
• 关键词: Address; Aftercare; Alcohol abuse; Blue Cross; Collaborations; Combined Modality Therapy; Communication; Computers; Counseling; Drug Addiction; Effectiveness; Health; Health Personnel; Health Services; Health Services Research; Healthcare Systems; Institutes; Intervention; Mediator of activation protein; Modeling; Motivation; National Institute of Drug Abuse; Nicotine Dependence; Outcome; Pharmaceutical Preparations; Population; Preparation; Prevention; Process; Provider; Quality of life; Randomized; Research; Research Personnel; Resources; Rhode Island; Sampling; Services; Smoker; Smoking; Staging; Treatment outcome; Withholding Treatment; Work; addiction; base; behavior change; comparative; compare effectiveness; cost effective; cost effectiveness; ethnic minority population; follow-up; nicotine replacement; public health relevance; response; smoking cessation; therapy design; treatment effect; treatment strategy

DESCRIPTION (provided by applicant): This proposal is submitted in response to PA-07-119 (Health Services Research on the Prevention and Treatment of Drug and Alcohol Abuse) from NIDA and addresses major gaps in health services research for nicotine addiction treatments for entire populations of smokers and for the 80% who are not motivated to quit. Nicotine addiction is just like other drug addictions in terms of breaking the addiction cycle. This research will be done in collaboration with the Health and Wellness Institute founded for dissemination purposes by Blue Cross of Rhode Island which serves over 70% of the state. Health service researchers and providers differ on whether treatment emphasis should be on clinician-based counseling, biologically-based medications, computer-based tailored communications or a combination of these. There is a lack of comparative research on population treatments to compare effectiveness, cost-effectiveness and enhancement of quality of life. Such comparative research would provide health care systems and providers with evidence on how to best serve entire populations of smokers, especially unmotivated smokers who are seriously underserved. This research will compare the four most highly recommended treatments: 1. Motivation Enhancement Therapy (MET) plus NRT; 2. Reduction Therapy plus NRT; 3.Tailored communications based on the Transtheoretical Model (TTM), and 4. The combination of these treatments. A five group randomized comparative treatment design will compare MET, Reduction, TTM Tailored and combined treatments and assess multiple outcomes at 0, 6, 12, 18 and 24 months. The study will proactively screen the health care system population to identify a sample of 2,500 smokers, including 2,000 unmotivated smokers. Secondary aims will examine cessation outcome trajectories (No Treatment Effects, Stable Effects after treatment, Decreasing Effects or Increasing Effects), and potential mediators of how the treatments work. PUBLIC HEALTH RELEVANCE: If the treatment combining Motivation Enhancement, Reduction Counseling, Nicotine Replacement Therapy and Transtheoretical tailored interventions produces an increasing treatment trajectory, it will produce unprecedented impacts with unmotivated smokers specifically and population cessation generally. These recruitment and intervention strategies require limited resources from health care providers and could be readily disseminable to other health care systems for application with populations of smokers, especially unmotivated smokers who have been understudied and underserved.

说明(由申请人提供)：本提案是根据NIDA的PA-07-119(预防和治疗药物和酒精滥用的卫生服务研究)提交的，旨在解决卫生服务研究中针对整个吸烟者和80%没有戒烟动机的尼古丁成瘾治疗的主要空白。就打破成瘾循环而言，尼古丁成瘾就像其他药物成瘾一样。这项研究将与罗德岛州蓝十字为传播目的而建立的健康与健康研究所合作进行，该研究所服务于该州70%以上的地区。卫生服务研究人员和提供者在治疗重点应该是基于临床医生的咨询、基于生物的药物、基于计算机的量身定制的交流还是这些方面的组合上存在分歧。缺乏关于人口治疗的比较研究，以比较疗效、成本效益和提高生活质量。这样的比较研究将为卫生保健系统和提供者提供证据，说明如何最好地为整个吸烟者提供服务，特别是没有动力的吸烟者，他们的服务严重不足。这项研究将比较四种最受推崇的治疗方法：1.动机增强疗法(MET)+NRT；2.减少疗法+NRT；3.基于跨理论模型(TTM)的量身定制的沟通；4.这些疗法的组合。一项五组随机比较治疗设计将比较MET、Reduction、TTM量身定制和联合治疗，并在0、6、12、18和24个月评估多种结果。这项研究将主动对医疗保健系统人群进行筛查，以确定2500名吸烟者的样本，其中包括2000名没有动机的吸烟者。次级目标将检查停止结果的轨迹(无治疗效果、治疗后稳定效果、减少效果或增加效果)，以及治疗如何起作用的潜在中介因素。与公共健康相关：如果结合动力增强、减少咨询、尼古丁替代疗法和跨理论量身定制干预的治疗产生越来越多的治疗轨迹，它将对无动机的吸烟者产生前所未有的影响，并在总体上停止吸烟。这些招募和干预战略需要来自卫生保健提供者的有限资源，可以很容易地传播到其他卫生保健系统，适用于吸烟者群体，特别是没有得到充分研究和服务的无动机吸烟者。