Preventing Relapse Following Involuntary Smoking Abstinence

说明(申请人提供)：吸烟是这个国家发病率和死亡率的头号可预防原因8、9。对于那些试图戒烟的人来说，防止复发是重中之重，因为大多数尝试戒烟的人在很短的时间内复发10。在接受正式戒烟计划的吸烟者中，至少70%的人复发10；在自动戒烟者中，复吸率约为90%11。然而，事实是，绝大多数试图戒烟的吸烟者在没有或得到最少帮助的情况下戒烟12。随着该领域直接向强调传播的方向发展，基于人群的方法，如戒烟热线和互联网干预，正变得越来越普遍13-15 16。虽然绝大多数吸烟者试图自行戒烟，但令人惊讶的是，关于减少自我戒烟者复发的研究很少。布兰登和他的同事6、17、7已经证明，一系列打印的8本自助小册子在自行戒烟的吸烟者中持续产生更高的时点戒烟率。鉴于这种方法对公众健康的巨大影响，显然需要更多关于促进长期自我戒烟的研究。到目前为止，几乎所有关于促进戒烟的研究都是在参与者在参与干预措施6、7之前自愿戒烟的样本中进行的。然而，对于防止非自愿戒烟后复发的方法(例如，军事训练、住院期间、监狱和精神病院)，人们一无所知。之前的研究1，2已经确定，在没有其他干预的情况下，军队中长期的非自愿戒烟与显著的长期戒断率(一年的随访率为15%-20%)有关。据我们所知，由于没有研究成功地干预长期非自愿戒断后的复发率，我们的具体目标如下：(1)在基本军事训练(BMT)结束时招募大约5200名美国空军(USAF)新兵，他们是在BMT期间非自愿戒烟8周前经常吸烟的人；(2)将参与者随机分为：(A)标准强制戒烟，(B)强制戒烟+印刷品(在先前的研究中被证明对自愿戒烟的人有效)，(C)强制戒烟+3个主动预防复发电话，或(D)强制戒烟+印刷品+3个主动预防复发电话，采用2 x 2因素设计(印刷品是与否，与主动电话治疗交叉，是与否)。(3)确定戒烟维持干预的长期(12个月)疗效。我们的主要结果是在12个月的随访中保持戒烟状态。次要结果是在6个月的随访中保持戒烟状态。 与公共健康相关：尽管开展了大规模的活动，但超过22%的美国成年人吸烟。绝大多数人试图自己戒烟，但大多数都失败了。目前的这项研究将测试帮助那些非自愿戒烟的人保持禁欲的方法。由于吸烟是这个国家导致过早死亡和发病的头号原因，该项目的公共卫生意义很高。

DESCRIPTION (provided by applicant): Cigarette smoking is the number one preventable cause of morbidity and mortality in this nation 8, 9. Preventing relapse is a high priority for those attempting to quit smoking as most people who attempt cessation relapse within a very short period of time 10. Of smokers who receive a formal cessation program, at least 70 percent relapse 10; among self-quitters, the relapse rate is approximately 90 percent 11. It is the case, however, that the vast majority of smokers who try to stop smoking do so with no or with minimal assistance 12. Population-based approaches such as tobacco quit lines and internet interventions are becoming increasingly more prevalent 13-15 16 as the field moves directly towards an emphasis on dissemination. While the vast majority of smokers try to quit on their own, surprisingly little research has been conducted on reducing relapse among self-quitters. Brandon and colleagues 6, 17 7 have demonstrated that a series of 8 printed self-help booklets consistently produced higher point-prevalence abstinence rates in smokers that had quit on their own. Given the enormous public health implications of this approach, more research on promoting long-term self-quitting is clearly needed. Virtually all research to date on promoting self-quitting has been conducted in samples where participants have voluntarily stopped smoking prior to participating in the interventions 6, 7. However, nothing is known about methods of preventing relapse following involuntary abstinence (e.g., military training, during hospital stays, in jails, prisons, & psychiatric facilities). Previous research 1, 2 has determined that protracted involuntary cessation in the military with no other intervention is associated with significant long-term cessation rates (15- 20 percent at a one-year follow-up). Since, to our knowledge, no study has successfully intervened to reduce relapse rates following a protracted involuntary abstinence, our specific aims are as follows: (1) To recruit approximately 5200 United States Air Force (USAF) recruits at the end of Basic Military Training (BMT) who were regular smokers prior to an 8-week involuntary cessation during BMT; (2) To randomize participants either to (a) standard forced cessation, (b) forced cessation + printed materials (proven to be efficacious in previous studies among those who voluntarily quit on their own), (c) forced cessation + 3 proactive relapse prevention telephone calls, or (d) forced cessation + printed materials + 3 proactive relapse prevention telephone calls, in a 2 x 2 factorial design (printed materials yes vs. no crossed with proactive telephone treatment, yes vs. no). (3) To determine the long-term (12 month) efficacy of the cessation maintenance intervention. Our primary outcome is smoking cessation maintenance at the 12 month follow-up. The secondary outcome is smoking cessation maintenance at the 6 month follow-up. PUBLIC HEALTH RELEVANCE: Despite large campaigns, over 22 percent of adult Americans smoke. The vast majority of people try to quit smoking on their own but most fail at these attempts. The current study will test ways of helping people who have quit involuntarily to maintain their abstinence. Since smoking is the #1 cause of premature mortality and morbidity in this country, the public health significance of this project is high.