Internet-Based Smoking Cessation for OEF/OIF Veterans

项目背景：从伊拉克和阿富汗返回的退伍军人吸烟率很高， 患吸烟相关疾病的风险增加。强化专科门诊 戒烟计划具有很高的效率，比不那么密集的计划更具成本效益 方法，并采用大多数VA医疗中心。然而，这些方案是 退伍军人很少参加，限制了对患病率，疾病负担和经济的影响 吸烟的费用。基于互联网的戒烟干预可能是一种有效的，低成本的 实施基于证据的戒烟原则的方法。互联网可以大大 通过避免障碍， 限制现有诊所服务的使用。 项目目标：本研究的目标是评估基于互联网的干预措施在以下方面的影响： 与标准VA专科诊所护理在促进返回患者戒烟方面的比较 老兵因此，具体目标和假设是： 目的1：评估基于互联网的戒烟干预对吸烟率的影响。 3个月和12个月时的戒烟率（自我报告的7天时点普遍戒烟率） 治疗后随访。假设1：退伍军人的禁欲率将显着提高 随机分配到基于网络的干预比那些随机分配到VA专业戒烟护理。 目的2：评估基于互联网的戒烟干预对吸烟人群的影响。 戒烟治疗。假设2.1：基于互联网的治疗将扩大覆盖面 这是以接受治疗的病人比例来衡量的。假设2.2：基于互联网 治疗将导致参与治疗，这是通过患者的比例来衡量的， 至少有一次戒烟尝试。 目的3：评价标准专科护理干预对患者的相对成本效益。 网络干预。 项目方法：提出了一项试验，其中410名OEF/OIF退伍军人吸烟者将被随机分配到 接受基于互联网的戒烟干预和尼古丁替代疗法，或 转介到VA专业戒烟护理，其中包括行为治疗，团体咨询， 电话咨询、自助材料和选择戒烟援助（药物治疗）。 将在干预后3个月和12个月对参与患者进行调查。主 试验的结果是干预后3个月随访时的7天点戒烟率， 通过自我报告测量并通过可替宁测定验证。

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.