Developing a Smoking Cessation Intervention for Methadone Maintained Smokers

描述（由申请人提供）：75%以上接受美沙酮维持治疗的吸毒者是吸烟者。与普通人群相比，美沙酮患者遭受吸烟带来的身体后果不成比例，包括死亡率增加。然而，接受美沙酮治疗的吸烟者对戒烟和接受戒烟治疗感兴趣，而戒烟的药物滥用吸烟者不太可能使用药物。对美沙酮患者进行戒烟干预的少数研究表明，在治疗期间和治疗后立即烟草使用显著减少；然而，戒烟的人的百分比很小，几乎所有戒烟的人很快又重新开始吸烟。此外，所研究的干预措施很简单，而且是按照针对一般人群的指导方针制定的，可能没有考虑到药物滥用者的复杂需求。为了更好地帮助美沙酮维持吸烟者戒烟和维持烟草戒断，我们提出以下研究目的：(1)确定美沙酮维持吸烟者戒烟和长期烟草戒断的戒烟治疗结构和要素；(2)为维持美沙酮的吸烟者制定量身定制的强化戒烟干预手册；(3)在一项小型随机对照试验中，对美沙酮维持吸烟者进行量身定制的强化戒烟干预的近期和长期效果进行试点和评估。这项研究将包括两个项目。项目一将解决目标1，包括通过美沙酮诊所临床工作人员以及接受美沙酮维持治疗的当前和以前的吸烟者的焦点小组收集定性数据。从项目1收集的数据将为项目2提供信息，项目2将在一项小型随机对照临床试验中开发和试点一项针对美沙酮维持吸烟者的量身定制的强化戒烟干预措施（目标2和3）。我的目标是成为一名独立的临床研究者，在戒烟、定性和定量研究方法以及行为干预发展方面具有专业知识。我提出的职业发展计划包括指导和结构化课程：(1)定性研究方法和数据分析；(2)戒烟行为干预的发展和方法；(3)开展随机临床试验的方法学和后勤；(4)烟草使用流行病学；（五）先进的定量统计方法；(6)负责任的研究行为。此外，我将参加地方研讨会和国家科学会议。

DESCRIPTION (provided by applicant): Over 75% of drug abusers receiving methadone maintenance treatment are tobacco smokers. Methadone patients disproportionately suffer from the physical consequences of smoking, including increased mortality, compared to the general population. Yet, smokers receiving methadone treatment are interested in quitting and receiving tobacco cessation treatment, and drug abusing smokers who quit smoking are less likely to use drugs. The few studies of smoking cessation interventions in methadone patients have shown significant reductions in tobacco use during and immediately after treatment; however, the percentages of individuals who quit smoking were small and nearly all those who quit quickly returned to smoking. In addition, the interventions studied were simple and modeled after guidelines for the general population that may not have accounted for the complex needs of drug abusers. To better help methadone maintained smokers quit smoking and maintain tobacco abstinence, we propose a study with the following aims: (1) to determine the structure and elements of smoking cessation treatment that will help methadone maintained smokers quit smoking and maintain long-term tobacco abstinence; (2) to develop a manual for a tailored, intensive smoking cessation intervention for methadone maintained smokers; and (3) to pilot and evaluate in a small randomized controlled trial the immediate and long-term effects of a tailored, intensive smoking cessation intervention for methadone maintained smokers. This study will consist of two projects. Project One will address Aim 1 and involve collecting qualitative data through focus groups with methadone clinic clinical staff and current and previous smokers receiving methadone maintenance treatment. The data collected from Project One will inform Project Two, to develop and pilot in a small randomized controlled clinical trial a tailored, intensive smoking cessation intervention for methadone maintained smokers (Aims 2 and 3). My goal is to become an independent clinical investigator with expertise in smoking cessation, qualitative and quantitative research methods, and behavioral intervention development. The Career Development Plan I have proposed includes mentorship and structured coursework in: (1) qualitative research methods and data analyses; (2) behavioral intervention development and methods for smoking cessation; (3) methodology and logistics of conducting randomized clinical trials; (4) epidemiology of tobacco use; (5) advanced quantitative statistical methods; and (6) responsible conduct of research. In addition, I will participate in local seminars and national scientific meetings. PUBLIC HEALTH RELEVANCE: Reducing tobacco use and increasing smoking cessation attempts among adults are objectives of Healthy People 2010, and determining the effectiveness of interventions targeting persons with co- occurring risk behaviors was identified as a priority in the National Institutes of Health State-of-the- Science Conference Statement on Tobacco Use. We hope to help methadone maintained smokers quit smoking and maintain tobacco abstinence by developing and evaluating and new smoking cessation intervention.