Gain-framed Messages and NRT Sampling to Promote Smoking Cessation in Lung Cancer Screening Programs

项目摘要/摘要 肺癌现在是美国男性和女性癌症死亡的主要原因。除了 一级预防(烟草控制)，通过低剂量CT扫描早期发现的二级预防是 被认为是一种在高危患者中识别早期、更多可治疗肺癌的技术。证据 来自国家肺部筛查试验(NLST)的研究表明，使用低剂量CT扫描进行肺癌筛查 高危人群(吸烟30年，戒烟15岁，55-74岁)的比例为20%。 每年接受3次低剂量CT扫描的患者死亡率降低。美国的预防性 服务业特别工作组(USPSTF)最近发布了#年肺癌年度筛查的最终建议 这些高危个人和许多保险公司现在都覆盖了筛查。因此，本研究是及时的和 新奇-我们将调查在这种高水平下，我们是否可以实现更高的短期和长期戒断率 风险人群。我们将进行2x2(增益框架干预与非框架干预，入门包 2周的尼古丁贴片和含片与不用药的对比)评估方法以提高 在两项研究中，不同动机水平的高危吸烟者(N=616)戒烟 网站(MUSC，耶鲁)。参与者将通过MUSC和耶鲁大学肺癌筛查计划确定 在两个地点都有。随机化将根据研究地点和动机水平进行分层。主要的假设是 在对吸烟者进行肺部筛查后的6个月内，戒烟率将显著提高。 戒烟策略，包括增益框架干预+2周尼古丁贴片和含片的比较 一种无框架的行为干预+不用药的策略。我们的第二个假设是 与非框架干预组相比，增加框架干预组的戒烟率更高 尼古丁贴片和含片2周的起始包与未用药组比较。在An上 在探索性的基础上，我们还将检查治疗的调解人和主持人。我们假设情况会发生变化 在自我效能感、戒烟效果预期、熟悉NRT、动机和自主性方面 将作为戒烟效果的机制(即，将作为治疗的中介)。我们也 假设肺部筛查结果(例如，是否存在结节、癌症等)、尼古丁依赖以及 健康差异将改变治疗反应(即，将充当治疗的基线主持人)。这 项目被设计为可翻译的(因为它可以从我们的受控疗效研究转移到其他 其他机构的肺部筛查计划)由于我们所有的媒体都将是准备共享的数字文件， NRT抽样程序将很容易复制，打印材料可以作为可填写的模板提供 为了个性化。

PROJECT SUMMARY/ABSTRACT Lung cancer is now the leading cause of cancer death in both men and women in the U.S. In addition to primary prevention (tobacco control), secondary prevention through early detection with low-dose CT scans is recognized as a technique to identify earlier stage, more treatable lung cancers in high-risk patients. Evidence from the National Lung Screening Trial (NLST) showed that lung cancer screening with low-dose CT scans for high risk individuals (>30 pack years of smoking, <15 yr quit-time, and 55-74 yrs of age) conferred a 20% reduction in mortality for those patients who received 3 annual low dose CT scans. The U.S. Preventive Services Task Force (USPSTF) recently issued a final recommendation for annual screening for lung cancer in these high risk individuals, and many insurers now cover the screening. The present study is thus timely and novel – we will investigate whether we can achieve higher rates of short- and long-term cessation in this high risk population. We will conduct a 2 x 2 (gain-framed intervention vs. unframed intervention, starter package of 2 weeks of nicotine patches and lozenges vs. no medication) study to evaluation methods to boost rates of smoking cessation for a high-risk group of smokers (N=616) with varying levels of motivation across 2 study sites (MUSC, Yale). Participants will be identified through the MUSC and Yale lung cancer screening programs at both sites. Randomization will be stratified by study site and level of motivation. The primary hypothesis is that rates of smoking cessation will be significantly higher at 6-months after lung screening for the smoking cessation strategy involving a gain-framed intervention + 2 weeks of nicotine patches and lozenges compared to a strategy of an unframed behavioral intervention + no medication. Our secondary hypothesis is that rates of smoking cessation will be higher for the gain-framed intervention group vs. the unframed intervention group and the starter package of 2 weeks of nicotine patches and lozenges group vs. the no medication group. On an exploratory basis we will also examine mediators and moderators of treatment. We hypothesize that changes in self-efficacy, smoking cessation outcome expectancy, familiarization with NRT, motivation, and autonomy will act as mechanisms for the smoking cessation effects (i.e., will act as mediators of treatment). We also hypothesize that lung screening findings (e.g., presence of a nodule, cancer, etc), nicotine dependence, and health disparities will modify treatment response (i.e., will act as baseline moderators of treatment). This project is designed to be translational (in that it can be transferable from our controlled efficacy study to other lung screening programs at other institutions) as all of our media will be digital files ready for sharing, the procedures for NRT sampling will be easily copied, and the print materials can be provided as fillable templates for personalization.