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(申请人提供)：在低收入人群中，吸烟的流行率很高，与烟草有关的疾病负担很大。有效的、有证据的戒烟疗法是可用的，但与高收入和白人吸烟者相比，低收入和少数族裔吸烟者使用这些疗法的可能性较小，特别是最全面的形式，包括药物疗法和密集的行为咨询相结合。在这项应用中，我们测试了一种新的积极主动的推广策略，与免费尼古丁替代疗法(NRT)相结合，以增加戒烟治疗对不同的低收入吸烟者的人口影响。人口影响是治疗利用(即达到或暴露)和治疗效果(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免费和容易的循证治疗，以治疗传统医疗保健系统以外的烟草依赖。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目前的吸烟者，其中包含有针对性的健康信息；2)促进获得免费、全面、循证的烟草依赖治疗，形式为NRT和以电话为基础的强化行为咨询。我们的具体目标是：1)比较主动外展联合免费NRT和电话咨询(PRO+NRT+TC)和常规护理(UC)对不同低收入吸烟者人群水平戒烟率的影响；2)比较PRO+NRT+TC和常规护理UC对人群水平烟草治疗利用率的影响；以及3)确定PRO+NRT+TC的成本效益。这项提案将对参加明尼苏达州医疗保健计划(MHCP)的成年吸烟者进行基于人口的抽样(N=2500)，以检验干预的效果。明尼苏达州医疗保健计划是一项由州政府资助的低收入者健康保险计划。基线数据将从MHCP行政数据库和在随机化之前进行的参与者调查中获得。结果数据将从随机化和MHCP管理数据后12个月进行的后续调查中收集。主要结果是长期戒烟(6个月)，并将在人口层面进行评估。所有随机抽样的个人都将被要求完成后续调查，无论他们是否参与了烟草治疗。主要目标的数据分析将遵循意向治疗方法学。研究团队在不同低收入人群中的烟草治疗研究、积极主动的推广和电话咨询方面拥有独特的相关经验。我们将与北美Quitline联盟合作，传播研究结果。如果有效，积极的烟草治疗将降低与烟草相关的发病率、死亡率和低收入美国人的医疗费用。 公共卫生相关性：在低收入人群中，吸烟的流行率很高，烟草相关疾病的负担也很高。迫切需要增加获得有效的烟草依赖治疗的机会。我们建议严格评估积极主动的外展，加上免费的NRT和电话咨询，对烟草依赖治疗对人群的影响。如果被证明是有效的和具有成本效益的，在全国范围内传播积极的治疗方法将减少与烟草相关的发病率、死亡率和低收入美国人的医疗费用。