Effectiveness of Proactive Tobacco Treatment in Diverse Low Income Smokers

主动烟草治疗对不同低收入吸烟者的有效性

• 批准号: 8137807
• 负责人: STEVEN FU
• 金额: $ 33.11万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-23 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8137807
• 关键词: Abstinence; Adult; Affect; Age-Years; American; Behavioral; Caring; Cigarette; Clinical; Clinical Trials; Collaborations; Combination Drug Therapy; Counseling; Coupled; Data; Data Analyses; Disease; Economics; Effectiveness; Enrollment; Ethnic Origin; Evidence based treatment; Female; Funding; Gender; Goals; Health; Health Care Costs; Health Insurance; Health Personnel; Health Services Accessibility; Healthcare; Healthcare Systems; High Prevalence; Income; Individual; Intervention; Knowledge; Life; Low Income Population; Low income; Mails; Mediator of activation protein; Methodology; Minnesota; Minority; Morbidity - disease rate; Motivation; Outcome; Participant; Patients; Persons; Pharmacotherapy; Population; Population Heterogeneity; Poverty; Provider; Qualifying; Race; Randomized; Randomized Controlled Trials; Readiness; Research; Research Design; Sampling; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Survey Methodology; Surveys; Telephone; Testing; Time; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Treatment Efficacy; United States; Withholding Treatment; Work; administrative database; base; cost; cost effective; cost effectiveness; effective therapy; evidence base; experience; federal poverty level; follow-up; health disparity; interest; intervention effect; mortality; nicotine replacement; novel; outreach; population based; primary outcome; programs; public health relevance; quitline; secondary outcome; smoking cessation; stressor; theories; treatment as usual; willingness

DESCRIPTION (provided by applicant): There is a high prevalence of smoking and high burden of tobacco related disease among low income populations. Effective, evidenced-based smoking cessation treatments are available, but low-income and minority smokers are less likely than higher-income and white smokers to use these treatments, especially the most comprehensive forms that include a combination of pharmacotherapy and intensive behavioral counseling. In this application, we test a novel proactive outreach strategy, coupled with free nicotine replacement therapy (NRT) to increase the population impact of tobacco cessation treatment for diverse, low income smokers. Population impact is the product of treatment utilization (i.e., reach or exposure) and treatment efficacy (i.e., smoking abstinence rates among those who utilize treatment); therefore, the theory- driven approach will systematically offer low income smokers free and easy access to evidence-based treatment for tobacco dependence outside the traditional health care system. The intervention has two primary components: 1) proactive outreach to current smokers in the form of mailed invitation materials and telephone calls containing targeted health messages, and 2) facilitated access to free, comprehensive, evidence-based treatment for tobacco dependence in the form of NRT and intensive, telephone-based behavioral counseling. Our specific aims are to: 1) compare the effect of proactive outreach combined with free NRT and telephone counseling (PRO+NRT+TC) to usual care (UC) on population-level smoking abstinence rates among a diverse population of low income smokers, 2) compare the effect of PRO+NRT+TC to usual care UC on population-level tobacco treatment utilization rates, and 3) determine the cost-effectiveness of PRO+NRT+TC. This proposal will examine the effects of the intervention in a population-based sample (N=2500) of adult smokers enrolled in the Minnesota Health Care Programs (MHCP), a state-funded health insurance plan for low income persons. Baseline data will be obtained from MHCP administrative databases and a participant survey that will be conducted prior to randomization. Outcome data will be collected from a follow-up survey conducted 12 months after randomization and MHCP administrative data. The primary outcome is prolonged smoking abstinence (6 months) and will be assessed at the population level. All randomized individuals will be asked to complete the follow-up survey, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. The study team has unique, relevant experience with tobacco treatment studies in diverse, low income populations, proactive outreach and telephone counseling. We will work in partnership with the North American Quitline Consortium to disseminate study findings. If effective, proactive tobacco treatment would reduce tobacco- related morbidity, mortality and health care costs for low income Americans. PUBLIC HEALTH RELEVANCE: There is a high prevalence of smoking and high burden of tobacco related disease among low income populations. There is a critical need to increase access to effective tobacco dependence treatments. We propose to rigorously evaluate the effects of proactive outreach coupled with free NRT and telephone counseling on the population impact of tobacco dependence treatment. If proven to be effective and cost- effective, national dissemination of proactive treatment approaches would reduce tobacco-related morbidity, mortality, and health care costs for low income Americans.

描述（由申请人提供）：低收入人群中吸烟率很高，烟草相关疾病的负担很高。提供有效的，有证据的基于证据的戒烟治疗方法，但是低收入和少数族裔吸烟者使用这些治疗方法的可能性较小，尤其是最全面的形式，包括药物治疗和强化行为咨询的结合。在此应用程序中，我们测试了一种新型的积极主动的外展策略，再加上免费的尼古丁替代疗法（NRT），以增加烟草戒烟治疗对多种低收入吸烟者的人口影响。人口影响是治疗利用（即覆盖或暴露）和治疗功效（即使用治疗的人的戒烟率）的产物；因此，理论驱动的方法将系统地为低收入吸烟者提供自由，轻松地使用传统医疗保健系统之外的烟草依赖的循证治疗。干预措施有两个主要组成部分：1）以邮寄邀请材料和包含有针对性的健康消息的邮寄邀请材料和电话的形式积极主动向目前的吸烟者进行宣传，以及2）促进以NRT和基于电话的，基于电话的行为咨询形式获得免费，全面，基于证据的基于循证的烟草依赖的方法。 Our specific aims are to: 1) compare the effect of proactive outreach combined with free NRT and telephone counseling (PRO+NRT+TC) to usual care (UC) on population-level smoking abstinence rates among a diverse population of low income smokers, 2) compare the effect of PRO+NRT+TC to usual care UC on population-level tobacco treatment utilization rates, and 3) determine the cost-effectiveness of Pro+NRT+TC。该提案将检查干预措施在明尼苏达州医疗保健计划（MHCP）的基于人群样本（n = 2500）中的影响，这是一项针对低收入人士的国家资助的健康保险计划。基线数据将从MHCP管理数据库中获得，并在随机分组之前进行的参与者调查。结果数据将从随机分组和MHCP管理数据后12个月进行的后续调查中收集。主要结果是长时间的戒烟（6个月），将在人群水平上进行评估。无论他们是否参加烟草治疗，所有随机人都将被要求完成后续调查。主要目的的数据分析将遵循意图对治疗方法。研究团队在各种，低收入人群，主动的外展和电话咨询方面具有独特的相关经验。我们将与北美Quitline联盟合作，以传播研究结果。如果有效，主动的烟草治疗将减少与低收入美国人相关的烟草发病率，死亡率和医疗保健费用。 公共卫生相关性：低收入人群中吸烟的患病率很高和与烟草相关的疾病负担很高。迫切需要增加获得有效的烟草依赖性治疗方法。我们建议严格评估积极主动的外展的影响以及免费的NR​​T和电话咨询对烟草依赖治疗的人口影响的影响。如果被证明是有效且具有成本效益的，那么全国对积极治疗方法的传播将减少与烟草相关的发病率，死亡率和医疗保健费用，以减少美国人的低收入美国人。