Randomized Trial of a Smoking Cessation Program for Persons with SMI

SMI 患者戒烟计划的随机试验

• 批准号: 8195952
• 负责人: LISA B. DIXON
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-10-01 至 2013-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8195952
• 关键词: Abstinence; Address; Aftercare; American Lung Association; Attention; Behavior Therapy; Behavioral; Biological; Bupropion; Carbon Monoxide; Categories; Cessation of life; Characteristics; Cigarette; Clinic; Clinical Practice Guideline; Cocaine; Cognitive; Communities; Department of Defense; Diabetes Mellitus; Diagnostic; Disabled Persons; Disease; Drug usage; Education; Effectiveness; Ensure; Face; Funding; General Population; Goals; Grant; Guidelines; Health; Health Care Costs; Health care facility; Healthcare; Healthcare Systems; Heart Diseases; Heroin; Impairment; Intervention; Life; Malignant neoplasm of lung; Maryland; Measures; Medical Economics; Mental Health; Mental disorders; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Nicotine Dependence; Obesity; Outcome; Participant; Patient Self-Report; Patients; Persons; Pharmacotherapy; Phase; Policies; Population; Procedures; Public Health; Randomized; Randomized Clinical Trials; Readiness; Recruitment Activity; Reporting; Research; Schizophrenia; Series; Severities; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Social support; Specific qualifier value; Substance Addiction; Substance Use Disorder; Substance abuse problem; Technology; Testing; Tobacco use; United States; United States Agency for Healthcare Research and Quality; Veterans; Withholding Treatment; Work; abstracting; addiction; base; cigarette smoking; contingency management; cost; design; evidence base; follow-up; handicapping condition; health care quality; improved; innovation; meetings; mortality; nicotine replacement; novel strategies; outreach; programs; psychologic; public health relevance; randomized trial; smoking cessation; social; social model; substance abuser; therapy development; tool; treatment program; trial comparing

Abstract Over 70% of people with serious and persistent mental illnesses (SPMI) smoke cigarettes. We have found that delivery of the 5 As of smoking cessation (Ask, Advise, Assess, Assist, Arrange) to persons with SPMI, a practice required by the VA, produces modest reductions in smoking and some increased use of smoking cessation aids, but does not increase abstinence. Existing "best practices" for smoking cessation in SPMI produce low short-term abstinence rates and almost no sustained abstinence. A new approach is needed that is designed for persons with SPMI and utilizes all available strategies for addiction treatment. We have developed an intervention called "Behavioral Treatment of Smoking Cessation in SPMI" (BTSCS), an innovative program that supplements pharmacotherapy and education with contingency management and a multifaceted behavioral group treatment that addresses the cognitive, motivational, and social support problems characteristic of people with SPMI. We propose to conduct a randomized trial of BTSCS compared to a manualized standard cessation program (StSST) that reflects current best practices. BTSCS was modeled after a successful program (Behavioral Treatment of Substance Abuse in SPMI) created by the study team that was designed for people with dual disorders. Hypotheses: We hypothesize that BTSCS will be more effective than StSST in producing and sustaining abstinence as measured by self report and expired CO levels. Subject Population: We will recruit 210 people with SPMI who smoke at least 10 cigarettes per day from the VA Maryland Healthcare System. We expect to randomize 178 people. Procedures: Participants in both conditions will receive brief outreach. Research assessments will be completed at baseline, 3 months (end of treatment), and 3- and 6- month follow ups. Potential Impact on Veterans' Health Care: The VA has recognized the high medical, economic, and social costs of smoking with directives to ensure that veterans are offered cessation programs. Testing an innovative smoking cessation treatment for persons with SPMI is highly significant for the VA because: (1) the rates of smoking among veterans are higher that the general population; (2) smoking rates among persons with SPMI are higher still, and; (3) there are virtually no smoking cessation treatments for veterans with SPMI that are effective in producing abstinence.

抽象的 超过 70% 患有严重和持续性精神疾病 (SPMI) 的人吸烟 香烟。我们发现戒烟后 5 个 As 的交付（询问、建议、 对患有 SPMI 的人员进行评估、协助、安排），这是 VA 要求的做法，产生 适度减少吸烟量并增加戒烟辅助工具的使用，但是 不会增加禁欲。 SPMI 现有的戒烟“最佳实践” 短期戒断率较低，而且几乎没有持续戒断率。一个新的 需要专为 SPMI 患者设计并利用所有可用的方法 成瘾治疗策略。我们开发了一种名为“行为干预”的干预措施 SPMI 戒烟治疗”（BTSCS）是一项创新计划， 通过应急管理和应急管理来补充药物治疗和教育 多方面的行为团体治疗，解决认知、动机和 SPMI 患者的社会支持问题是其特征。我们建议开展一次 BTSCS 与手动标准戒烟计划相比的随机试验 （StSST）反映了当前的最佳实践。 BTSCS 是在成功的 研究团队创建的项目（SPMI 中药物滥用的行为治疗） 这是专为患有双重疾病的人设计的。 假设：我们假设 BTSCS 在生产方面比 StSST 更有效 和 通过自我报告和呼出的二氧化碳水平来衡量持续禁欲。 受试者人群：我们将招募 210 名患有 SPMI 且吸烟至少 10 支的人 每天来自 VA 马里兰州医疗系统的香烟。我们期望随机化 178 人。 程序：两种情况的参与者都将收到简短的外展服务。研究 评估将在基线、3个月（治疗结束）、3个月和6个月时完成 月跟进。 对退伍军人医疗保健的潜在影响：退伍军人管理局已经认识到高医疗、 吸烟的经济和社会成本，并发出指令以确保为退伍军人提供服务 戒烟计划。测试一种针对患有烟瘾的人的创新戒烟疗法 SPMI 对于 VA 来说非常重要，因为：(1) 退伍军人的吸烟率 高于一般人群； (2) SPMI 患者的吸烟率为 更高，并且； (3) 对于有烟瘾的退伍军人来说，几乎没有戒烟治疗。 SPMI 可有效产生禁欲。