Developing a Smoking Cessation Intervention for Methadone Maintained Smokers

描述（申请人提供）：超过75%接受美沙酮维持治疗的滥用药物者是吸烟者。与一般人群相比，美沙酮患者不成比例地遭受吸烟的身体后果，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，而戒烟的吸毒者使用药物的可能性较小。少数美沙酮患者戒烟干预研究显示，治疗期间和治疗后立即烟草使用显著减少;然而，戒烟者的百分比很小，几乎所有戒烟者都很快恢复吸烟。此外，所研究的干预措施很简单，是按照一般人群的准则制定的，可能没有考虑到药物滥用者的复杂需要。 为了更有效地协助美沙酮成瘾者戒烟及维持戒烟，我们建议进行一项研究，目的如下：（1）确定有助美沙酮成瘾者戒烟及维持长期戒烟的戒烟治疗的结构及元素;（2）为美沙酮成瘾者制订一份针对性的密集戒烟干预手册;（3）为美沙酮成瘾者提供一个全面的戒烟治疗。以及（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即时和长期效果进行试验和评估。 这项研究将包括两个项目。第一个项目将针对目标1，并通过与美沙酮诊所临床工作人员以及目前和以前接受美沙酮维持治疗的吸烟者的焦点小组收集定性数据。从项目一收集的数据将告知项目二，在一项小型随机对照临床试验中开发和试点一种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，拥有戒烟，定性和定量研究方法以及行为干预开发方面的专业知识。我提出的职业发展计划包括以下方面的指导和结构化课程：（1）定性研究方法和数据分析;（2）行为干预发展和戒烟方法;（3）进行随机临床试验的方法和后勤;（4）烟草使用的流行病学;（5）先进的定量统计方法;（6）负责任的研究行为。此外，我还将参加地方研讨会和国家科学会议。 公共卫生相关性：减少烟草使用和增加成年人的戒烟尝试是2010年健康人的目标，确定针对具有共同发生的风险行为的人的干预措施的有效性被确定为美国国立卫生研究院烟草使用科学状态会议声明的优先事项。我们希望通过开发和评估新的戒烟干预措施，帮助美沙酮维持者戒烟和维持戒烟。

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.