A Test of Two Clinical Methods to Prompt a Quit Attempt Among Tobacco Smokers

两种促使吸烟者尝试戒烟的临床方法的测试

• 批准号: 8539479
• 负责人: JOHN R HUGHES
• 金额: $ 56.47万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8539479
• 关键词: Abstinence; Adult; Cigarette; Clinical; Cognitive; Control Groups; Counseling; Equilibrium; Guidelines; Healthcare; Hour; Incidence; Intervention; Lead; Mediating; Methods; Newsletter; Nicotine Dependence; Outcome; Public Health; Randomized; Recruitment Activity; Relative (related person); Self Efficacy; Smoker; Smoking; Telephone; Testing; Thinking; Time; Tobacco; United States Public Health Service; base; clinically relevant; effective intervention; efficacy testing; motivational enhancement therapy; motivational intervention; nicotine replacement; quitline; tobacco control; treatment as usual

DESCRIPTION (provided by applicant): Despite tobacco control interventions, the incidence of quitting among US adult smokers has not increased in the last decade. One new method to increase quit attempts is to have smokers reduce their cigs/day. We and others have shown that reduction aided by NRT can increase quit attempts and later abstinence among smokers not ready to quit. Because half of smokers are reluctant to use NRT for a non-cessation reason, we now propose to test whether reduction not aided by NRT can be effective. Another new method to increase quit attempts is motivational counseling. Although some studies have found "motivational interviewing" prompts quit attempts, this treatment is intensive (median time = 1.7 hours) and thus not practical in many settings. We previously found implementation of the USPHS Guidelines 5 Rs motivational intervention via three 15 min phone calls can provide a large increase in quitting (OR = 6.3). However, that study employed a no treatment control group~ thus, we propose to test for efficacy using a more clinically-relevant usual care control condition. We will proactively call adult, daily smokers to recruit 850 smokers who do not plan to quit in the next month and randomize them to a) reduction counseling without the aid of NRT, b) counseling guided by the USPHS 5 R's, or c) usual care. The first two conditions will be delivered via brief counseling calls at study onset and then 2 and 4 weeks later (total = 35 min). The usual care condition will consist of a brief (< 5 min) "2 As" intervention and three newsletters providing information on quitting sent at these same times. Our major hypothesis is that the incidence of quit attempts over the 6 months of the study will be greater in both the reduction and the 5 Rs conditions than in the usual care condition. A secondary hypothesis is that the increase in quit attempts will lead to increased abstinence. Another secondary hypothesis is that beneficial effects of both treatments will be mediated by increases in self-efficacy and intentions to quit. A final hypothesis is that decreases in cigs/day and nicotine dependence will mediate the efficacy of the reduction treatment but not the 5 Rs treatment and, conversely, that a shift in decisional balance will mediate the efficacy of the 5 Rs treatment but not of the reduction treatment. If our two interventions are effective, this would encourage quitlines, healthcare organizations and clinicians to offer these time-limited interventions to ambivalent smokers. Also, having an action-oriented intervention (reduction) and a cognitive-oriented intervention (5 Rs) could increase the acceptability of these interventions to different types of smokers. Finally, prior studies have been interpreted to indicate that reducing cigs/day will increase later quitting~ however, all prior studies that have shown this included NRT to aid reduction~ thus, it may be that pretreatment, not reduction is the cause of any increase quitting in prior studies. A study showing that reduction without the aid of NRT increases later quitting would be the first direct test to indicate reduction per se aids later quitting.

描述（由申请人提供）：尽管采取了烟草控制干预措施，但美国成年吸烟者的戒烟率在过去十年中并未增加。 增加戒烟尝试的一种新方法是让吸烟者减少每天的吸烟量。我们和其他人已经证明，通过尼古丁替代疗法（NRT）辅助戒烟可以增加尚未准备好戒烟的吸烟者的戒烟尝试和后来的戒烟。 由于一半的吸烟者出于非戒烟原因不愿意使用 NRT，因此我们现在建议测试不通过 NRT 辅助的戒烟是否有效。 另一种增加戒烟尝试的新方法是动机咨询。 尽管一些研究发现“动机访谈”会促使人们尝试戒烟，但这种治疗方法强度较大（中位时间 = 1.7 小时），因此在许多情况下并不实用。 我们之前发现，通过 3 个 15 分钟的电话实施 USPHS 指南 5 卢比的激励干预可以大幅提高戒烟率（OR = 6.3）。 然而，该研究采用了未治疗的对照组~因此，我们建议使用与临床更相关的常规护理对照条件来测试疗效。 我们将主动召集每日吸烟的成年吸烟者，招募 850 名不打算在下个月戒烟的吸烟者，并将他们随机分配到 a) 不借助 NRT 的戒烟咨询，b) 由 USPHS 5 R 指导的咨询，或 c) 常规护理。前两种情况将在研究开始时以及 2 周和 4 周后通过简短的咨询电话提供（总计 = 35 分钟）。通常的护理条件将包括简短（< 5 分钟）的“2 As”干预和同时发送的三份提供戒烟信息的时事通讯。 我们的主要假设是，在研究的 6 个月内，在减少条件和 5 Rs 条件下尝试戒烟的发生率均高于常规护理条件下的戒烟尝试发生率。 第二个假设是，戒烟尝试的增加将导致戒烟的增加。 另一个次要假设是，两种治疗的有益效果将通过自我效能感和戒烟意愿的提高来调节。 最后的假设是，每天抽支烟和尼古丁依赖的减少将调节减少治疗的功效，但不会调节 5 Rs 治疗的功效，相反，决策平衡的转变将调节 5 Rs 治疗的功效，但不会调节减少治疗的功效。如果我们的两项干预措施有效，这将鼓励戒烟热线、医疗机构和临床医生向矛盾的吸烟者提供这些限时干预措施。 此外，以行动为导向的干预（减少）和以认知为导向的干预（5卢比）可以提高不同类型吸烟者对这些干预措施的接受度。 最后，先前的研究表明，减少每天吸烟的数量 会增加后来的戒烟~然而，所有先前的研究都表明这包括 NRT 来帮助减少戒烟~因此，在先前的研究中，戒烟增加的原因可能是预处理，而不是减少。 一项研究表明，在不使用 NRT 的情况下减少戒烟会增加以后戒烟，这将是第一个表明减少本身有助于以后戒烟的直接测试。