A Test of Two Clinical Methods to Prompt a Quit Attempt Among Tobacco Smokers

两种促使吸烟者尝试戒烟的临床方法的测试

• 批准号: 8394538
• 负责人: JOHN R HUGHES
• 金额: $ 61.51万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8394538
• 关键词: Abstinence; Adult; Cigarette; Clinical; Cognitive; Control Groups; Counseling; Equilibrium; Guidelines; Healthcare; Hour; Incidence; Intervention; Lead; Mediating; Methods; Newsletter; Nicotine Dependence; Outcome; Public Health; Randomized; Recruitment Activity; Relative (related person); Self Efficacy; Smoker; Smoking; Telephone; Testing; Thinking; Time; Tobacco; United States Public Health Service; base; clinically relevant; effective intervention; efficacy testing; motivational enhancement therapy; motivational intervention; nicotine replacement; quitline; tobacco control; treatment as usual

DESCRIPTION (provided by applicant): Despite tobacco control interventions, the incidence of quitting among US adult smokers has not increased in the last decade. One new method to increase quit attempts is to have smokers reduce their cigs/day. We and others have shown that reduction aided by NRT can increase quit attempts and later abstinence among smokers not ready to quit. Because half of smokers are reluctant to use NRT for a non-cessation reason, we now propose to test whether reduction not aided by NRT can be effective. Another new method to increase quit attempts is motivational counseling. Although some studies have found "motivational interviewing" prompts quit attempts, this treatment is intensive (median time = 1.7 hours) and thus not practical in many settings. We previously found implementation of the USPHS Guidelines 5 Rs motivational intervention via three 15 min phone calls can provide a large increase in quitting (OR = 6.3). However, that study employed a no treatment control group~ thus, we propose to test for efficacy using a more clinically-relevant usual care control condition. We will proactively call adult, daily smokers to recruit 850 smokers who do not plan to quit in the next month and randomize them to a) reduction counseling without the aid of NRT, b) counseling guided by the USPHS 5 R's, or c) usual care. The first two conditions will be delivered via brief counseling calls at study onset and then 2 and 4 weeks later (total = 35 min). The usual care condition will consist of a brief (< 5 min) "2 As" intervention and three newsletters providing information on quitting sent at these same times. Our major hypothesis is that the incidence of quit attempts over the 6 months of the study will be greater in both the reduction and the 5 Rs conditions than in the usual care condition. A secondary hypothesis is that the increase in quit attempts will lead to increased abstinence. Another secondary hypothesis is that beneficial effects of both treatments will be mediated by increases in self-efficacy and intentions to quit. A final hypothesis is that decreases in cigs/day and nicotine dependence will mediate the efficacy of the reduction treatment but not the 5 Rs treatment and, conversely, that a shift in decisional balance will mediate the efficacy of the 5 Rs treatment but not of the reduction treatment. If our two interventions are effective, this would encourage quitlines, healthcare organizations and clinicians to offer these time-limited interventions to ambivalent smokers. Also, having an action-oriented intervention (reduction) and a cognitive-oriented intervention (5 Rs) could increase the acceptability of these interventions to different types of smokers. Finally, prior studies have been interpreted to indicate that reducing cigs/day will increase later quitting~ however, all prior studies that have shown this included NRT to aid reduction~ thus, it may be that pretreatment, not reduction is the cause of any increase quitting in prior studies. A study showing that reduction without the aid of NRT increases later quitting would be the first direct test to indicate reduction per se aids later quitting. PUBLIC HEALTH RELEVANCE: New methods to prompt smokers to quit could have a significant public health impact. In a prior study, we found that, helping such smokers to reduce the number of cigarettes/day by counseling plus nicotine replacement therapy (NRT), or motivating them with brief discussions over the phone, both dramatically increased later quitting compared to no treatment. We now propose to re-test these treatments for three reasons: a) because most smokers are not willing to use NRT, we wish to see if reduction without using NRT is effective, b) we wish to test if our reduction and motivational treatments are better than current usual care and c) we wished to conduct a more rigorous experimental test.

描述（由申请人提供）：尽管采取了烟草控制干预措施，但在过去十年中，美国成年吸烟者的戒烟率并未增加。 一种增加戒烟尝试的新方法是让吸烟者减少每天的吸烟量。我们和其他人已经证明，NRT辅助下的减量可以增加戒烟尝试，并增加未准备戒烟的吸烟者的戒烟率。 由于一半的吸烟者不愿意使用NRT的非停止的原因，我们现在建议测试是否减少NRT的帮助下可以有效。 另一种增加戒烟尝试的新方法是动机咨询。 虽然一些研究发现“动机性访谈”会促使人们尝试戒烟，但这种治疗是密集的（中位时间= 1.7小时），因此在许多情况下并不实用。 我们以前发现，通过三个15分钟的电话实施USPHS指南5 Rs动机干预可以大幅增加戒烟率（OR = 6.3）。 然而，该研究采用了无治疗对照组，因此，我们建议使用更具临床相关性的常规护理对照条件来测试疗效。 我们将主动致电成年每日吸烟者，招募850名不打算在下个月戒烟的吸烟者，并将其随机分配至a）不借助NRT的减量咨询，B）USPHS 5 R指导的咨询，或c）常规护理。前两种情况将在研究开始时通过简短的咨询电话提供，然后在2周和4周后提供（总计= 35分钟）。通常的护理条件将包括一个简短的（< 5分钟）“2作为”干预和三个通讯提供戒烟信息发送在这些相同的时间。 我们的主要假设是，在研究的6个月内，减量和5 Rs条件下的戒烟尝试发生率均高于常规护理条件。 第二个假设是，戒烟尝试的增加将导致禁欲的增加。 另一个次要假设是，这两种治疗的有益效果将通过自我效能和戒烟意图的增加来介导。 最后一个假设是，烟支/天和尼古丁依赖的降低将介导减量治疗的疗效，而不是5 Rs治疗，相反，决策平衡的转变将介导5 Rs治疗的疗效，而不是减量治疗的疗效。如果我们的两种干预措施是有效的，这将鼓励戒烟热线，医疗保健组织和临床医生提供这些有时间限制的干预措施，以矛盾的吸烟者。 此外，具有以行动为导向的干预（减少）和以认知为导向的干预（5 R）可以增加这些干预措施对不同类型吸烟者的可接受性。 最后，先前的研究已经被解释为表明减少吸烟/天 将增加以后的戒烟率~然而，所有先前的研究都表明这包括NRT以帮助减少~因此，可能是预处理，而不是减少是先前研究中戒烟率增加的原因。 一项研究表明，在没有NRT的帮助下减少吸烟会增加后来的戒烟次数，这将是第一个直接表明减少吸烟本身有助于后来戒烟的测试。 公共卫生相关性：促使吸烟者戒烟的新方法可能会对公共卫生产生重大影响。 在之前的一项研究中，我们发现，通过咨询加尼古丁替代疗法（NRT）帮助这些吸烟者减少每天的吸烟量，或者通过电话进行简短的讨论来激励他们，与没有治疗相比，这两种方法都大大增加了后来的戒烟率。 我们现在建议重新测试这些治疗，原因有三：a）因为大多数吸烟者不愿意使用NRT，我们希望了解不使用NRT的减量是否有效，B）我们希望测试我们的减量和激励治疗是否优于目前的常规治疗，c）我们希望进行更严格的实验测试。