Reducing socioeconomic disparities in tobacco dependence treatment outcomes

减少烟草依赖治疗结果的社会经济差异

• 批准号: 8509786
• 负责人: Christine Elizabeth Sheffer
• 金额: $ 29.81万
• 依托单位: CITY COLLEGE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-12 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8509786
• 关键词: Abstinence; Address; Affect; African American; Behavior Therapy; Behavioral; Cognitive; Cognitive Therapy; Communities; Control Locus; Counseling; Development; Disease; Ensure; Environment; Exposure to; Feedback; Goals; Health; Health Personnel; Lead; Logistic Regressions; Manuals; Methods; Minority; Modeling; Participant; Persons; Population; Prevalence; Randomized; Relapse; Research; Risk; Risk Behaviors; Services; Smoke; Smoker; Smoking; Stress; Telephone; Testing; Time; Tobacco; Tobacco Dependence; Tobacco use; Treatment outcome; base; discounting; evidence base; experience; health disparity; high risk; improved; innovation; meetings; member; response; smoking cessation; socioeconomics; standard care; therapy design; treatment effect

DESCRIPTION (provided by applicant): Tobacco use is a leading contributor to racial and socioeconomic health disparities in the US primarily due to an unequal burden of tobacco-related disease from a disproportionate share of smokers in lower socioeconomic (SES) groups in which minorities, particularly African Americans, are disproportionately represented.1-5 Although deemed effective for all smokers,6 the standard cognitive-behavioral treatment for tobacco dependence is significantly less effective for lower SES smokers.7-15 Tobacco dependence treatment, however, has the potential to reduce racial and socioeconomic disparities in achieving long-term abstinence by proactively providing our most at-risk smokers with the specific treatment components they need to achieve abstinence through the existing extensive treatment delivery system.16, 17 Our preliminary studies indicate that in addition to several socio-cultural barriers to engaging in treatment,18 there are several key factors associated with socioeconomic disparities in relapse rates and thus treatment outcomes. These factors include: stress, negative affect, smoking in response to negative affect, delay discounting, locus of control, impulsiveness, exposure to smokers in the environment, and treatment utilization (see Table 1).19, 20 Based on this and other evidence, our overall goal is to revise the standard treatment with specific, evidence-based, cognitive-behavioral strategies to address these key factors as well as target and tailor the approach to more fully meet the needs of lower SES and minority smokers, thereby reducing treatment outcome disparities. We expect: 1) The revised treatment (RT) to reduce socioeconomic disparities in treatment outcomes, and 2) Participants treated with the RT to demonstrate more improvement on each of the key factors associated with disparities than those treated with standard treatment (ST). The specific aims include: 1) Complete a revised draft of a widely utilized standard treatment manual that addresses each of the key factors with treatment components. This aim is partially accomplished (see Appendix for preliminary draft). 2) Using the PEN-3 Model,21-23 target and tailor the daft RT to more fully represent the experiences of smokers who are of lower SES and /or of minority status, particularly African American smokers. 3) Pilot test the targeted/tailored draft RT with three treatment groups (n=5-10 per group) to assess understandability and acceptability and to ensure that it can be delivered in the same timeframe as the ST. 4) Compare the effects of SES on treatment outcomes with socioeconomically and racially diverse participants treated with ST (n=110) and RT (n=110) in a randomized treatment design. 5) Compare the effects of treatment condition on each of the key factors. This innovative approach refines, improves upon, and applies theoretically derived and empirically supported concepts and strategies. If effective at reducing treatment outcome disparities, the manual-driven RT will be easily disseminable as a "new" standard, having a sustained and powerful impact on the field and contributing to a reduction in the magnitude of the present tobacco-related racial and socioeconomic health disparities.

描述（由申请人提供）：烟草使用是造成美国种族和社会经济健康差异的主要原因，主要是由于社会经济地位较低 (SES) 群体中吸烟者比例过高，导致与烟草相关的疾病负担不平等，而在该群体中，少数族裔（尤其是非裔美国人）所占比例过高。1-5 虽然该标准被认为对所有吸烟者都有效，6 对于社会经济地位较低的吸烟者来说，针对烟草依赖的认知行为治疗的效果明显较差。7-15 然而，烟草依赖治疗有可能通过现有广泛的治疗系统主动为高危吸烟者提供他们实现戒烟所需的特定治疗成分，从而减少实现长期戒烟的种族和社会经济差异。16, 17 我们的初步研究表明， 除了参与治疗的一些社会文化障碍之外，18还有几个与复发率和治疗结果的社会经济差异相关的关键因素。这些因素包括：压力、负面影响、针对负面影响而吸烟、延迟贴现、控制点、冲动、在环境中接触吸烟者以及治疗利用（见表 1）。19, 20 根据这一证据和其他证据，我们的总体目标是 采用具体的、基于证据的认知行为策略修改标准治疗，以解决这些关键因素，并针对和定制方法，以更充分地满足较低社会经济地位和少数吸烟者的需求，从而减少治疗结果差异。我们期望：1) 修订后的治疗 (RT) 能够减少治疗结果中的社会经济差异，以及 2) 与接受标准治疗 (ST) 治疗的参与者相比，接受 RT 治疗的参与者在与差异相关的每个关键因素上表现出更大的改善。具体目标包括： 1) 完成广泛使用的标准治疗手册的修订草案，该手册解决了治疗组成部分的每个关键因素。这一目标已部分实现（初稿见附录）。 2) 使用 PEN-3 模型，21-23 目标并定制 daft RT，以更全面地代表社会经济地位较低和/或少数群体身份的吸烟者，特别是非裔美国吸烟者的经历。 3) 用三个治疗组（每组 n=5-10）对目标/定制草案 RT 进行试点测试，以评估其可理解性和可接受性，并确保它可以在与 ST 相同的时间范围内交付。 4) 在随机治疗设计中，比较 SES 对接受 ST (n=110) 和 RT (n=110) 治疗的社会经济和种族多样化参与者的治疗结果的影响。 5）比较治疗条件对各关键因素的影响。这种创新方法完善、改进并应用了理论推导和经验支持的概念和策略。如果能够有效减少治疗结果差异，手动驱动的 RT 将作为“新”标准轻松传播，对该领域产生持续而强大的影响，并有助于缩小目前与烟草相关的种族和社会经济健康差异的程度。