Health Advocates as a Vehicle to Improve Treatment for Smokers in Public Housing

描述（由申请人提供）：戒烟是吸烟者可以采取的有益于健康的最重要的一步。然而，低收入吸烟者在戒烟方面不如高收入吸烟者成功。如果这些在吸烟和戒烟率方面的社会经济差异持续存在，低收入吸烟者将承担越来越多的与吸烟有关的发病率和死亡率的不同负担。因此，迫切需要采取干预措施提高低收入吸烟者的戒烟率。戒烟治疗方案，如电话戒烟热线和基于诊所的方案是存在的，但没有得到充分利用，特别是低收入吸烟者。我们建议在公共住房居民中进行一项组随机试验，以测试使用接受过戒烟特殊培训的居民社区健康倡导者（烟草治疗倡导者（TTAs））是否可以提高(1)戒烟热线和诊所项目的利用率，以及(2)公共住房吸烟者的戒烟率。波士顿的20个公共住房开发（博士）将被随机分配接受TTA干预或增强标准护理，每种情况招募250名吸烟者。每位参与者的干预期为6个月，6个月后进行最终结果评估。在干预中，博士和TTAs将与吸烟者进行7-9次互动，以激励他们使用治疗方案，协助确定哪个方案最能满足他们的需求，主动将吸烟者与方案联系起来，解决参与方案的后勤问题和其他障碍，加强和增加咨询信息，鼓励充分利用方案，包括坚持服药，并在治疗期间和治疗后为戒烟提供社会支持。对照博士项目的参与者将与一名助教会面一次，助教将向他们提供符合当地文化的自助材料以及戒烟热线和诊所项目提供的戒烟服务信息。该研究的主要结果将是：(1)使用Quitline或基于临床的戒烟服务（包括治疗剂量），以及(2)在第3、7和12个月测量的7天和30天生物化学验证的戒烟。结果的数据来源，以及假设的中介和调节因素，将包括戒烟热线和诊所记录，TTA记录，以及在四个时间点进行的问卷调查。对每增加一笔戒烟费用的成本效益评价将提供关于传播潜力的资料。

DESCRIPTION (provided by applicant): Quitting smoking is the most important step that smokers can take to benefit their health. However, low-income smokers are less successful in quitting than higher-income smokers. If these socioeconomic disparities in smoking and smoking cessation rates persist, low-income smokers will bear an increasingly disparate burden of smoking-related morbidity and mortality. Therefore, interventions to improve the rate of smoking cessation among low-income smokers are urgently needed. Smoking cessation treatment programs such as telephone quitlines and clinic-based programs exist but are underutilized, particularly by low-income smokers. We propose to conduct a group-randomized trial among public housing residents to test whether the use of resident Community Health Advocates with special training in smoking cessation (Tobacco Treatment Advocates (TTAs) can improve (1) utilization of quitlines and clinic-based programs and (2) smoking cessation rates among smokers in public housing. Twenty public housing developments (PHDs) in Boston will be randomly assigned to receive either the TTA intervention or enhanced standard care, with 250 smokers recruited for each condition. The intervention period for each participant will last 6 months, with final outcome assessment 6 months later. At intervention PHDs and TTAs will have 7-9 interactions with smokers to motivate them to use a treatment program, assist in determining which program best meets their needs, proactively connect smokers to programs, address logistical problems and other barriers to program participation, reinforce and augment counseling messages, encourage full utilization of programs including adherence to medication, and provide social support for quitting during and after treatment. Participants at control PHDs will meet once with a TTA who will provide them with culturally-appropriate self-help materials and information on smoking cessation services available through the Quitline and clinic-based programs. The primary outcomes for the study will be (1) utilization of Quitline or clinic-based cessation services (including dose of treatment), and (2) 7-and 30-day biochemically-verified smoking abstinence measured at 3, 7, and 12 months. Data sources for outcomes, as well as hypothesized mediators and moderators, will include quitline and clinic records, TTA records, and questionnaires administered at four time points. A cost-effectiveness evaluation of the cost per additional quit will provide information on the potential for disseminability. PUBLIC HEALTH RELEVANCE: Quitting smoking is the most important step that smokers can take to benefit their health, but low-income smokers are less successful in quitting than higher-income smokers. Interventions to improve the rate of smoking cessation among low-income smokers are urgently needed, or else these smokers will bear an increasingly disparate burden of smoking-related disease and death. Using residents from low-income communities, such as public housing, to help their fellow residents quit smoking may be an effective method to increase the rate of smoking cessation.