Technology-Enhanced Quitline Services to Prevent Smoking Relapse

描述（由申请人提供）：每年有超过1900万的美国吸烟者戒烟超过一天，试图戒烟，但只有5%的人能坚持戒烟一年，大多数人在戒烟后一个月内又重新吸烟。戒烟后复吸是一个重要的健康问题，也是试图保持戒烟的个人面临的最严重的问题。本研究的目的是测试IVR技术在增强广泛使用的烟草治疗服务交付模式（Free & Clear's Quit for Life(R) program）的有效性，以防止吸烟复发并实现戒烟。我们的技术将通过以下方式加强戒烟热线服务：(1)筛查戒烟后复发风险增加的个人；(2)根据个人现有的风险因素提供基于证据的电话咨询。使用IVR监测，将筛选个体复发风险增加的具体指标，包括戒烟、身体戒断症状、抑郁症状、感知压力、戒烟自我效能降低和戒烟动机降低。除了这些公认的复发预测因素外，还有令人信服的证据表明，戒烟后的前两周复发的风险最大。因此，我们建议比较两种模式的时间和频率的IVR筛选。在技术增强的戒烟热线（TEQ）部门，10个主动的IVR呼叫将在戒烟后的8周内以递减的频率进行（前两周每周两次，然后每周一次）。在高强度技术增强戒烟热线（HI-TEQ）中，在戒烟后的8周内（前两周每天，然后每周），将放置20个主动IVR呼叫。拟议的研究是一项随机对照试验，比较戒烟6个月和戒烟12个月的成本效益。将比较三个治疗组，即(1)标准戒烟终身护理，(2)IVR监测吸烟复发风险结合电话戒烟治疗服务（TEQ），(3)高频监测吸烟复发风险结合电话戒烟治疗服务（HI-TEQ）。受试者将从基于电话戒烟治疗项目的三个大客户（两个雇主和一个健康计划客户）中招募。如果成功，这一干预措施可纳入现有的戒烟热线规程，并提供给数百万正在努力戒烟的个人，从而满足传播有效戒烟干预措施的重大公共卫生需求。

DESCRIPTION (provided by applicant): Each year, over 19 million Americans smokers stop smoking for more than one day in an attempt to quit smoking, yet as few as 5% will maintain abstinence for one year, with most returning to smoking within one month of quitting. Relapse after smoking cessation is an important health concern and is the most significant problem faced by individuals who are attempting to maintain abstinence from smoking. The purpose of this study is to test the efficacy of IVR technology for enhancing a widely used tobacco treatment service delivery model (Free & Clear's Quit for Life(R) program) to prevent smoking relapse and achieve abstinence. Our technology will enhance quitline services through (1) screening individuals during the post quit date period for increased risk of relapse and (2) providing evidence-based telephone counseling at the point of need tailored to the individual's extant risk factors. Using IVR monitoring, individuals will be screened for specific indicators of increased risk for relapse including smoking lapse, physical withdrawal symptoms, depressive symptoms, perceived stress, decreased self-efficacy for quitting, and decreased motivation to quit. In addition to these well-established predictors of relapse, there is compelling evidence to suggest that the risk of relapse is most intense during the first two weeks post-quit. Thus we propose to compare two models for timing and frequency of IVR screening. In the Technology Enhanced Quitline (TEQ) arm, 10 proactive IVR calls will be placed at decreasing frequency for 8 weeks post-quit (twice a week for the first two weeks, then weekly). In the High Intensity Technology-Enhanced Quitline (HI-TEQ) arm, 20 proactive IVR calls will be placed over the 8 weeks post-quit (daily for the first 2 weeks, then weekly). The proposed study is a randomized controlled trial to compare smoking abstinence and cost-effectiveness at 6 and 12 months among participants in the Quit for Life quitline program. Three treatment groups will be compared, namely (1) standard Quit for Life care, (2) IVR monitoring of risk for smoking relapse in combination with telephone-based tobacco cessation treatment service (TEQ), and (3) high frequency monitoring of risk for smoking relapse in combination with telephone- based tobacco cessation treatment service (HI-TEQ). Subjects will be recruited from three large clients (two employers and one health plan client) of the Free & Clear Quit for Life telephone-based tobacco cessation treatment program. If successful, this intervention could be incorporated into existing quitline protocols and delivered to millions of individuals who are trying to quit smoking, meeting a significant public health need for the dissemination of effective smoking cessation interventions.