Enhancing cancer outreach for low-income adults with innovative smoking cessation

描述（由申请人提供）：最近的证据表明，目前美国成年人吸烟的流行率已降至20%以下。虽然这一下降令人鼓舞，但吸烟仍然是美国可预防的发病率和死亡率的主要原因。此外，在某些人口群体中，如教育水平低的人和生活在贫困线或贫困线以下的人，吸烟率要高得多。因此，针对这些服务不足的人群进行有效的戒烟治疗是一项重要的公共卫生工作。这项分组随机试验的总体目标是设计和评估一种针对未投保和投保不足的个人的新型戒烟计划。拟议研究的主要内容将是利用已建立的社区网站网络（例如，社区中心和教堂）和一个移动的单位，使我们能够接触到在利用更传统的戒烟治疗方法方面面临重大障碍的个人。 本研究的具体目的是：1）在一项分组随机试验中，比较三种戒烟干预措施针对社区低收入未保险和保险不足的个人的疗效。干预措施将包括标准护理（SC）方法，包括戒烟的简短建议，尼古丁替代疗法（NRT）和自助书面材料;增强护理（EC）方法，包括标准护理组件加上单一的健康反馈和动机访谈咨询会议以及手机传递的文本/图形消息组件;和重症监护（IC）方法，包括所有SC和EC组件加上一系列的11个手机提供的主动咨询会议和手机提供的文本/图形消息组件; 2）评估戒烟动机、尼古丁戒断、风险感知、自我效能、社会支持和消极情感作为戒烟潜在中介的作用; 3）比较三种治疗方案的成本-效果。 我们认为，在这三个条件中，IC将最成功地解决低收入吸烟者的需求，原因有几个。首先，IC计划将是个性化的，个性化的，并配备了通过手机提供的密集，扩展的咨询和支持模块。第二，该计划将结合联合收割机三个干预组成部分，具有保持支持和动机戒烟和防止复发的高潜力。第三，IC干预利用手机技术--在调查小组以前进行的研究中，这种方法在低收入吸烟者中已经证明了可行性和有效性。拟议的研究提供了一些特点（服务靠近居住地，提供手机等）。这可能会减少治疗障碍，同时提高参与者的招募和保留。

DESCRIPTION (provided by applicant): Recent evidence indicates that the prevalence of current cigarette smoking among adults in the US has dropped below 20%. While this drop is encouraging, smoking still represents the leading cause of preventable morbidity and mortality in the US. Moreover, smoking prevalence is significantly higher among certain population groups, such as those with low levels of education and those living at, or below the poverty level. Therefore, efforts to target these underserved populations with efficacious smoking cessation treatments represents a vital public health effort. The overarching goal of this group-randomized trial is to design and evaluate a novel smoking cessation program targeted to uninsured and underinsured individuals. Key elements of the proposed study will be the use of an established network of community sites (e.g., community centers and churches) and a mobile unit, enabling us to reach individuals confronted with significant barriers to utilizing more traditional smoking cessation treatment approaches. Specific aims of the study will be to: 1) Compare the efficacy of three smoking cessation interventions targeting community based low income uninsured and underinsured individuals in a group-randomized trial. The interventions will include a Standard Care (SC) approach, consisting of brief advice to quit smoking, nicotine replacement therapy (NRT), and self-help written materials; an Enhanced Care (EC) approach, consisting of the standard care components plus a single health feedback and motivational interviewing counseling session and a cell phone-delivered text/graphical messaging component; and an Intensive Care (IC) approach, consisting of all SC and EC components plus a series of 11 cell phone-delivered proactive counseling sessions and a cell phone-delivered text/graphical messaging component; 2) Evaluate the role of quit motivation, nicotine withdrawal, risk perception, self- efficacy, social support, and negative affect as potential mediators of smoking abstinence; and 3) Compare the cost-effectiveness of the three treatment conditions. We believe that of the three conditions, the IC will most successfully address the needs of low-income smokers for several reasons. First, the IC program will be personalized, individualized, and equipped with an intensive, extended counseling and support module provided over the cell phone. Second, the program will combine three intervention components featuring high potential for maintaining support and motivation to quit and prevent relapse. Third, the IC intervention makes use of cell phone technology - an approach that has demonstrated feasibility and efficacy among low-income smokers in previous research conducted by the investigative team. The proposed study offers a number of features (proximity of services to the place of residence, provision of cell phones, etc.) that are likely to reduce treatment barriers while enhancing participant recruitment and retention.