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高，烟草相关疾病负担重。有效的、循证的戒烟治疗是可用的，但低收入和少数民族吸烟者不太可能比高收入和白色吸烟者使用这些治疗，特别是最全面的形式，包括药物治疗和强化行为咨询的组合。在本申请中，我们测试了一种新的主动外展策略，加上免费尼古丁替代疗法（NRT），以增加戒烟治疗对不同低收入吸烟者的人群影响。人口影响是治疗利用的产物（即，到达或暴露）和治疗功效（即，利用治疗的人的戒烟率）;因此，理论驱动的方法将系统地为低收入吸烟者提供免费和方便的循证治疗，以治疗传统医疗保健系统之外的烟草依赖。该干预措施有两个主要组成部分：1）以邮寄邀请材料和电话的形式主动接触当前吸烟者，其中包含有针对性的健康信息; 2）以NRT和密集的电话行为咨询的形式促进获得免费，全面，循证的烟草依赖治疗。我们的具体目标是：1）比较主动外展结合免费NRT和电话咨询（PRO+NRT+TC）与常规护理（UC）对不同低收入吸烟者人群的人群水平戒烟率的影响，2）比较PRO+NRT+TC与常规护理UC对人群水平烟草治疗利用率的影响，3）确定PRO+NRT+TC的成本效益。该提案将研究干预措施对参加明尼苏达州医疗保健计划（MHCP）的成年吸烟者的人群样本（N=2500）的影响，该计划是一项针对低收入人群的国家资助的健康保险计划。将从MHCP管理数据库和随机化前进行的受试者调查中获得基线数据。将从随机化后12个月进行的随访调查中收集结局数据和MHCP管理数据。主要结局是长期戒烟（6个月），并将在人群水平上进行评估。将要求所有随机化个体完成随访调查，无论他们是否参与烟草治疗。主要目的的数据分析将遵循意向治疗方法。该研究小组在不同的低收入人群中进行烟草治疗研究，积极主动的外展和电话咨询方面具有独特的相关经验。我们将与北美戒烟联盟合作，传播研究结果。如果有效，积极的烟草治疗将减少低收入美国人与烟草有关的发病率、死亡率和医疗保健费用。 公共卫生相关性：在低收入人群中，吸烟率很高，烟草相关疾病的负担也很高。迫切需要增加获得有效烟草依赖治疗的机会。我们建议严格评估积极主动的推广加上免费NRT和电话咨询对烟草依赖治疗的人群影响的影响。如果被证明是有效的和具有成本效益的，全国传播的积极治疗方法将减少烟草相关的发病率，死亡率和低收入美国人的医疗保健费用。