Evaluation of Tobacco Treatment Strategies for Inpatient Psychiatry

住院精神病学烟草治疗策略的评估

• 批准号: 8425043
• 负责人: Judith J. Prochaska
• 金额: $ 35.78万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8425043
• 关键词: Abstinence; Accounting; Acute; Address; Adopted; Adult; Alcohols; American Psychiatric Association; Area; Behavioral; Budgets; Cardiovascular Diseases; Cigarette; Clinical Treatment; Cognitive; Community Hospitals; Computers; Counseling; Disease; Drug usage; Effectiveness; Evaluation; Future; Goals; Guidelines; Health; High Prevalence; Hospitalization; Illicit Drugs; Individual; Inpatients; K-Series Research Career Programs; Life; Lung diseases; Malignant Neoplasms; Manuals; Mediator of activation protein; Medical; Mental Health; Mental disorders; Mentors; Modeling; Nicotine Dependence; Participant; Patients; Persons; Physiological; Professional counselor; Psychiatric Hospitals; Psychiatry; Publishing; Randomized Clinical Trials; Randomized Controlled Trials; Readiness; Recruitment Activity; Reporting; Research; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Staging; Substance abuse problem; Symptoms; Time; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Treatment outcome; Withholding Treatment; base; brief intervention; cost; cost effectiveness; design; evidence base; follow-up; individualized feedback; multi-component intervention; nicotine replacement; patient population; public health relevance; severe mental illness; smoke-free policy; smoking cessation; success; treatment as usual; treatment strategy

ABSTRACT The overall goal of this research is to identify efficacious strategies for treating tobacco dependence among adult smokers hospitalized with severe mental illness. Nicotine dependence is the most prevalent substance abuse disorder among psychiatric patients, a group that accounts for a staggering 44% to 46% of the US tobacco market16, 17. In terms of dollars spent, this equates to $39 billion in annual tobacco sales18. While numerous trials have established the effectiveness of smoking cessation interventions for hospitalized medical patients, little research has targeted the acute psychiatric inpatient setting19. The American Psychiatric Association's tobacco treatment guidelines identify psychiatric hospitalization as an ideal opportunity for promoting smoking cessation1. Individuals with mental illness have lower quit rates and may be less motivated and prepared to quit in the near future than the general population20-22. Thus, sufficiently intense, multi- component interventions are needed that address both the physiological and behavioral aspects of nicotine dependence and assist smokers at all stages of readiness through the quitting process23. Using a three group additive design, the proposed randomized clinical trial (N=1100) aims to evaluate tobacco cessation treatments of varying intensities initiated in the acute psychiatric inpatient setting. The proposal builds upon Dr. Prochaska's K23 mentored career development award and seeks to determine: (i) whether the initial successes seen in an academic-based psychiatric hospital can be replicated in a larger and more diverse patient population recruited from a community hospital; and (ii) if more extended and intensive clinician-delivered treatment can outperform our current best practices. The three groups are: (1) Usual Care (N=150) consisting of brief cessation advice, a quit smoking guide, and nicotine replacement provided during hospitalization; (2) Brief Treatment (N=475) adds a stage-based manual, computer-delivered stage-tailored individualized feedback and brief cessation counseling sessions during hospitalization and repeated at months 3 and 6, and access to 12 weeks of nicotine replacement following hospitalization; (3) Extended Treatment (N=475) builds upon our current brief treatment and provides 12 additional weeks of nicotine replacement (24 weeks total) with individualized, counselor-delivered motivational and manualized cognitive behavioral cessation treatment. We hypothesize that the extended treatment will outperform the brief treatment, and that both treatment groups will be more effective than usual care in producing quit attempts and ultimately abstinence from cigarettes. Secondary aims will model the cost-effectiveness of the treatment conditions; examine moderators and mediators of treatment outcomes; and prospectively examine the relation between changes in smoking, mental health functioning, and use of other substances over time.

抽象的 本研究的总体目标是确定治疗烟草依赖的有效策略 成年吸烟者因严重精神疾病住院。尼古丁依赖是最普遍的物质 精神病患者中存在虐待障碍，这一群体占美国人口的 44% 至 46% 烟草市场16, 17。就花费的美元而言，这相当于烟草年销售额 390 亿美元18。尽管 大量试验已证实戒烟干预措施对住院医疗人员的有效性 患者，针对急性精神病住院患者的研究很少19。美国精神病学 协会的烟草治疗指南将精神病住院治疗视为一个理想的机会 促进戒烟1.患有精神疾病的人戒烟率较低，并且可能缺乏动力 准备在不久的将来戒烟的人数比一般人群高出20-22。因此，足够强烈的、多 需要采取综合干预措施来解决尼古丁的生理和行为方面的问题 并在戒烟过程的各个准备阶段为吸烟者提供帮助23。 使用三组附加设计，拟议的随机临床试验（N = 1100）旨在评估 在急性精神病住院患者中开始不同强度的戒烟治疗。这 该提案以 Prochaska 博士的 K23 指导职业发展奖为基础，旨在确定：(i) 学术型精神病医院的初步成功是否可以在规模更大、规模更大的精神病院中复制？ 从社区医院招募的患者群体更加多样化； (ii) 如果更广泛和更深入 临床医生提供的治疗可以优于我们当前的最佳实践。这三组是： (1) 常规护理 (N=150)，包括简短的戒烟建议、戒烟指南和尼古丁 住院期间提供更换； (2) 简短治疗（N=475）增加基于阶段的手动、计算机提供的阶段定制的个性化治疗 住院期间进行反馈和简短的戒烟咨询，并在第 3 个月和第 3 个月重复 6、住院后获得12周的尼古丁替代疗法； (3) 延长治疗 (N=475) 以我们目前的简短治疗为基础，并提供 12 项额外治疗 尼古丁替代周（总共 24 周），并由辅导员提供个性化的激励 和手动认知行为戒断治疗。 我们假设延长治疗将优于短期治疗，并且两个治疗组 在促使戒烟尝试并最终戒烟方面比常规护理更有效。 次要目标将模拟治疗条件的成本效益；检查主持人并 治疗结果的中介因素；并前瞻性地研究吸烟、精神变化之间的关系 健康功能以及随着时间的推移使用其他物质。

项目成果

E-cigarette use among smokers with serious mental illness.

• DOI: 10.1371/journal.pone.0113013
• 发表时间: 2014
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Prochaska JJ;Grana RA
• 通讯作者: Grana RA