Integrated Smoking Cessation Treatment for Low Income Community Corrections

说明(申请人提供)：刑事司法系统内个人的吸烟率大约是刑事司法系统外个人的3-4倍，几乎没有针对这一人群的戒烟干预措施。与等待名单对照组相比，一项针对女性囚犯的大型随机对照试验测试了尼古丁替代和10次小组干预，发现戒烟率与其他社区试验相似。然而，尽管有必要在低收入和其他服务不足的人群中测试吸烟干预措施，但尚未在社区惩教监督下对惩教机构以外的个人进行戒烟干预。拟议中的网站，社区矫正，有一个种族多元化(60%的非裔美国人)，低收入人口谁没有机会获得戒烟干预。这项研究建议使用安非他酮作为平台来检查两种不同的戒烟行为干预措施，这种低收入的成人人口按种族分层：4次会议，强化咨询干预与最初的医生咨询戒烟(护理标准)相比较。所有参与者都将接受安非他酮治疗12周，戒断率将根据基线的可替宁和过期的CO来确定，每周4次咨询会议，第8周和第12周(治疗结束)。后续将在学习注册后6个月、9个月和12个月进行。GEE分析将被用来检查干预在多个时间点上的效果，据信非裔美国吸烟者的戒烟率将继续低于白人吸烟者，尽管这种影响预计将通过激励性访谈干预而减弱。这项研究通过检查一种新的治疗提供环境(社区矫正)来完成RFA任务，该治疗提供环境(社区矫正)针对无法获得使用Buention的戒烟治疗的低收入人群，并比较两种行为治疗的强度。如果证明有效，这项研究将提供一个模式，将戒烟治疗纳入社区矫正罪犯的现有计划，以帮助为低收入和服务不足的人口提供治疗。 与公共健康相关：吸烟现在集中在低收入人群和其他弱势群体，如社区矫正。该项目有可能降低与吸烟相关的发病率和死亡率，这是一种低收入的社区矫正人群。

DESCRIPTION (provided by applicant): Smoking prevalence among individuals in the criminal justice system is approximately 3- 4 times higher than among individuals outside the criminal justice system and few smoking cessation interventions have targeted this population. One large RCT of female prisoners tested nicotine replacement and 10-session group intervention compared to a wait-list control group and found comparable cessation rates with other community trials. However, smoking cessation interventions have not been conducted with individuals outside penal institutions under community corrections supervision, despite the need to test smoking interventions with low income and other underserved populations. The proposed site, community corrections, has a racially diverse (60% African-American), low income population who do not have access to smoking cessation interventions. This study proposes to examine using bupropion as the platform to examine two different behavioral interventions for smoking cessation with this low income, adult population stratifying for race: a 4 session, intensive counseling intervention compared to an initial session of physician counseling to quit (standard of care). All participants will be treated for 12 weeks with bupropion and abstinence rates will be determine based on cotinine and expired CO for baseline, 4 weekly counseling sessions, weeks 8 and 12 (end-of- treatment). Follow-ups will be at 6, 9 and 12 months after study enrollment. GEE analyses will be used to examine the effect of the intervention over multiple time points and it is believed that African-American smokers will continue to have lower smoking cessation rates compared to Caucasian smokers, although this effect is expected to be attenuated using the motivational interviewing intervention. This study fulfills the RFA mission by examining a novel treatment delivery setting (community corrections) with a low income population who do not have access to smoking cessation treatment using buproprion and comparing two intensities of behavioral therapy. If efficacy is demonstrated, this study would provide a model for integrating smoking cessation treatment in existing programs for community corrections offenders to help provide treatment to a low income and underserved population. PUBLIC HEALTH RELEVANCE: Smoking is now concentrated in low income and other disadvantaged populations such as community corrections. Providing smoking cessation services integrated with community corrections has the potential to provide these services to a low income population who are not able to access community smoking cessation interventions due to lack of insurance and other poverty issues. This project has the potential to reduce the morbidity and mortality associated with smoking with this low income, community corrections population.