Internet-Based Smoking Cessation for OEF/OIF Veterans

项目背景：从伊拉克和阿富汗回国的退伍军人吸烟率很高，而且 患吸烟相关疾病的风险增加。以集约化专科诊所为基础 戒烟计划有很高的效果，比不那么密集的戒烟计划更具成本效益 大多数退伍军人医疗中心都采用了这种方法。然而，这些计划是 很少有退伍军人参加，限制了对流行率、疾病负担和经济的影响 吸烟的代价。基于互联网的戒烟干预可能是一种有效、低成本的方法 实施循证戒烟原则的方法。互联网可能会显著地 通过避免以下障碍来增加戒烟努力对当前方法的影响 限制现有诊所服务的使用。 项目目标：这项研究的目标是评估基于互联网的干预对 与标准退伍军人专科门诊服务在促进返乡戒烟方面的比较 退伍军人。因此，具体的目标和假设是： 目标1：评估基于互联网的戒烟干预对戒烟率的影响 3个月和12个月的戒烟情况(自我报告的7天点戒烟盛行) 治疗后随访。假设1：退伍军人的禁酒率要高得多 随机接受基于网络的干预的患者比随机接受退伍军人专科戒烟护理的患者更多。 目的2：评估基于互联网的戒烟干预对青少年的影响 戒烟治疗。假设2.1：基于互联网的治疗将导致覆盖范围的扩大 以患者获得护理的比例来衡量。假设2.2：基于互联网 治疗将导致参与治疗，以患者的比例来衡量 至少有一次退出尝试。 目的3：评价标准专科护理干预对老年人的相对成本-效果 基于网络的干预。 项目方法：建议进行一项试验，将410名OEF/OIF资深吸烟者随机分为 接受基于互联网的戒烟干预和尼古丁替代疗法，或者 转介到退伍军人管理局专业戒烟护理，包括行为治疗，团体咨询， 电话咨询、自助材料和戒烟辅助选择(药物疗法)。 参与的患者将在干预后3个月和12个月接受调查。初级阶段 试验的结果是在干预后3个月的随访中进行了7天的时点戒酒， 通过自我报告测量，并通过可替宁试验进行验证。

Project Background: Veterans returning from Iraq and Afghanistan are smoking at high rates and are at elevated risk for the development of smoking related illness. Intensive speciality clinic-based tobacco cessation programs have high efficacy, are more cost effective than less intensive approaches, and are employed by most VA medical centers. These programs, however, are infrequently attended by veterans, limiting the impact on prevalence, disease burden, and economic costs of smoking. An internet-based smoking cessation intervention could be an effective, low-cost method to implement evidence based smoking cessation principles. The internet could significantly increase the impact of smoking cessation efforts over current approaches by avoiding barriers that limit utilization of existing clinic-based services. Project Objectives: The goal of the study is to evaluate the impact of an internet-based intervention in comparison to standard VA speciality clinic-based care in promoting smoking cessation in returning veterans. Accordingly, the specific aims and hypotheses are: AIM 1: To evaluate the impact of an internet-based smoking cessation intervention on rates of abstinence from cigarettes (self-reported 7-day point prevalent abstinence) at 3 months and 12-month post-treatment follow-ups. Hypothesis 1: Abstinence rates will be significantly higher among veterans randomized to the web-based intervention than those randomized to VA specialty cessation care. AIM 2: To evaluate the impact of an internet-based smoking cessation intervention on reach of smoking cessation treatment. Hypothesis 2.1: Internet-based treatment will result in increased reach as measured by the proportion of patients who access care. Hypothesis 2.2: Internet-based treatment will result in engagement in treatment as measured by the proportion of patients that make at least one quit attempt. AIM 3: To evaluate the relative cost-effectiveness of the standard specialty care intervention to the web-based intervention. Project Methods: Proposed is a trial in which 410 OEF/OIF veteran smokers will be randomized to receive either an internet-based smoking cessation intervention and nicotine replacement therapy or referral to VA specialty smoking cessation care, which includes behavioral therapy, group counseling, telephone counseling, self-help materials, and choice of smoking cessation aid (pharmacotherapy). Participating patients will be surveyed at 3 months post-intervention and at 12 months. The primary outcome of the trial is a 7-day point prevalence abstinence at the 3-month post intervention follow-up, as measured by self-report and verified by cotinine assay.