Abstinence Reinforcement Therapy (ART) for Rural Veteran Smokers

农村老烟民的戒断强化治疗 (ART)

• 批准号: 8485369
• 负责人: PATRICK S. CALHOUN
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8485369
• 关键词: Abstinence; Aftercare; Alcohol abuse; Attention; Behavior Therapy; Behavioral; Biological Assay; Bypass; Carbon Monoxide; Caring; Cigarette; Clinic; Cognitive; Cotinine; Counseling; Data; Development; Drug usage; Economic Burden; Effectiveness; Effectiveness of Interventions; Evidence based treatment; Funding; Goals; Guidelines; Health; Health behavior change; Individual; Inpatients; Internet; Intervention; Life; Measures; Mediating; Mediator of activation protein; Medicine; Mental Depression; Methods; Monitor; Morbidity - disease rate; Outpatients; Pain; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Population; Positive Reinforcer; Post-Traumatic Stress Disorders; Psychological reinforcement; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Relative (related person); Risk; Rural; Secure; Self Efficacy; Services; Smoker; Smoking; Smoking Cessation Intervention; Substance Use Disorder; Surveys; Symptoms; Technology; Telephone; Therapeutic Intervention; Time; Treatment outcome; United States; Veterans; Withholding Treatment; arm; base; cigarette smoking; comparative effectiveness; contingency management; cost effective; cost effectiveness; design; effective intervention; effectiveness trial; evidence base; follow-up; high risk; improved; innovation; medical specialties; mortality; nicotine replacement; primary outcome; programs; rural area; smoking cessation; smoking intervention; telehealth; therapy design; treatment program; voucher

DESCRIPTION (provided by applicant): Project Background. Cigarette smoking is the most lethal substance use disorder in the United States in terms of morbidity and mortality. Unfortunately, smoking cessation treatment including smoking cessation aids such as nicotine replacement therapy are greatly underutilized. There is a special need to develop effective interventions that target rural Veterans. Veterans living in rural areas are at particular high risk for smoking related morbidity and mortality. Rural Veterans are significantly less likely to access intensive clinic-based smoking cessation care. While the efforts of our group and others have expanded reach of smoking cessation treatment options beyond the clinic to include tele-medicine, cognitive- behavioral telephone counseling, and internet based interventions, it has been suggested that there is a need of more innovative and intensive approaches to smoking cessation in order to improve quit rates, particularly in settings where treatment options are limited such as rural areas. The use of intensive behavioral therapies, such as contingency management (CM), may be a useful component for smoking cessation interventions among rural Veterans. CM has shown efficacy for reducing smoking in other difficult-to-treat populations. Project Objectives. The primary goal of the current study is o evaluate the effectiveness of an intervention that combines evidenced based treatment for smoking cessation with smart-phone based, portable contingency management on smoking rates compared to a contact control intervention in a randomized controlled trial among rural Veteran smokers. Specifically, Veterans will be randomized to receive Abstinence Reinforcement Therapy (ART) which combines evidenced based cognitive-behavioral telephone counseling (TC), a tele-medicine clinic for access to nicotine replacement (NRT), and mobile contingency management (mCM) or a control condition (i.e., TC and NRT alone) that will provide controls for therapist, medication, time and attention effects. The specific aims and hypotheses are: AIM 1: To evaluate the impact of ART on rates of abstinence from cigarettes at 3-month, 6- month, and 12-month post-treatment follow-ups. Hypothesis 1: Abstinence rates will be significantly higher among Veterans randomized to the ART-based intervention than those randomized to the control arm. AIM 2: To evaluate the relative cost-effectiveness of the ART intervention. Hypothesis 2: ART based treatment will result in greater cost-effectiveness compared to the control condition as measured by the incremental cost-effectiveness ratio. AIM 3: To evaluate potential treatment mediators including self-efficacy-related mechanisms. Hypothesis 3: Increased abstinence associated with ART will be partially mediated by increased self-efficacy compared to the contact-control condition. Project Methods. Proposed is a four year project in which 300 Veteran smokers will be randomized to receive either a multi-component Abstinence Reinforcement Therapy or a contact control intervention. Participating patients will be surveyed at 3-months, 6-months and 12-months post-randomization. The primary outcome of the trial is prolonged self-reported abstinence at the 6 month follow-up verified by cotinine assay.

描述（由申请人提供）： 项目背景。吸烟是美国发病率和死亡率最高的物质使用障碍。不幸的是，戒烟治疗，包括戒烟辅助，如尼古丁替代疗法，大大利用不足。特别需要制定针对农村退伍军人的有效干预措施。生活在农村地区的退伍军人吸烟相关的发病率和死亡率的风险特别高。农村退伍军人 明显不太可能获得基于诊所的密集戒烟护理。虽然我们小组和其他人的努力已经将戒烟治疗选择的范围扩大到诊所以外，包括远程医疗，认知行为电话咨询和基于互联网的干预措施，但有人建议需要更创新和更密集的戒烟方法，以提高戒烟率，特别是在治疗选择有限的环境中，如农村地区。使用强化行为疗法，如应急管理（CM），可能是农村退伍军人戒烟干预的一个有用组成部分。CM在其他难以治疗的人群中显示出减少吸烟的功效。项目目标。本研究的主要目标是在农村退伍军人吸烟者中进行的一项随机对照试验中，评价将基于证据的戒烟治疗与基于智能手机的便携式应急管理相结合的干预措施与接触控制干预措施对吸烟率的有效性。具体而言，退伍军人将随机接受禁欲强化疗法（ART），该疗法结合了基于证据的认知行为电话咨询（TC）、用于获得尼古丁替代品（NRT）的远程医疗诊所和移动的应急管理（mCM）或对照条件（即，TC和NRT单独），这将提供治疗师，药物，时间和注意力的影响控制。具体目标和假设是：目的1：评价ART对治疗后3个月、6个月和12个月随访时戒烟率的影响。假设1：禁欲率将显着较高的退伍军人随机分配到ART为基础的干预比那些随机对照arm.AIM 2：评估ART干预的相对成本效益。假设二：以增量成本效益比衡量，与对照条件相比，基于ART的治疗将产生更大的成本效益。目的3：评估潜在的治疗介质，包括自我效能相关机制。假设三：与接触控制条件相比，与ART相关的禁欲增加将部分由自我效能增加介导。项目方法。拟议的是一个为期四年的项目，其中300名退伍军人吸烟者将随机接受多组分戒烟强化治疗或接触控制干预。将在随机化后3个月、6个月和12个月对参与患者进行调查。试验的主要结局是6个月随访时通过可替宁测定验证的长期自我报告的禁欲。