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

项目总结/摘要 肺癌现在是美国男性和女性癌症死亡的主要原因。 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， 被认为是一种在高危患者中识别早期、更可治疗的肺癌的技术。证据 来自国家肺筛查试验（NLST）的研究表明，使用低剂量CT扫描进行肺癌筛查， 高风险个体（吸烟> 30包年，戒烟时间<15年，年龄55 - 74岁）给予20% 每年接受3次低剂量CT扫描的患者死亡率降低。美国预防 服务工作组（USPSTF）最近发布了肺癌年度筛查的最终建议， 这些高风险的个人，和许多保险公司现在涵盖的筛选。因此，本研究报告是及时的， 新的-我们将研究我们是否可以实现更高的短期和长期停止率在这个高 风险人群。我们将进行一个2 x 2（增益框架干预与非框架干预， 2周的尼古丁贴片和锭剂与无药物）研究，以评估提高 2项研究中动机不同的高风险吸烟者组（N = 616）的戒烟 地点（MUSC，Yale）。参与者将通过MUSC和耶鲁大学肺癌筛查计划进行识别 在这两个网站。将按照研究中心和动机水平对随机化进行分层。主要假设为 在肺部吸烟筛查后6个月， 戒烟策略，包括增益框架干预+2周尼古丁贴片和含片， 一种无框架的行为干预+不用药的策略。我们的次要假设是， 戒烟将更高的增益框架干预组与非框架干预组 以及2周尼古丁贴片和锭剂组与无药物组的初始包装。上 探索性的基础上，我们还将研究调解人和调解人的治疗。我们假设 自我效能、戒烟结果预期、NRT熟悉程度、动机和自主性 将作为戒烟效果的机制（即，将作为治疗的介质）。我们也 假设肺筛查发现（例如，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，将作为治疗的基线调节剂）。这 项目的设计是翻译（因为它可以从我们的对照疗效研究转移到其他 其他机构的肺筛查项目）由于我们所有的媒体都将是数字文件， NRT采样程序将很容易复制，打印材料可作为可填充模板提供 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.