Technology-Enhanced Quitline Services to Prevent Smoking Relapse

每年有超过1900万美国吸烟者戒烟超过一天，但只有5%的人会保持戒烟一年，大多数人在戒烟后一个月内重新吸烟。戒烟后复发是一个重要的健康问题，也是试图保持戒烟的人面临的最重要的问题。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提供模式（Free & Clear的Quit for Life（R）计划）以预防复吸和实现戒烟方面的有效性。我们的技术将通过以下方式加强戒烟热线服务：（1）在戒烟后的日期期间筛查个人复发的风险增加，以及（2）在需要时根据个人现存的风险因素提供基于证据的电话咨询。使用IVR监测，将对个体进行复吸风险增加的特定指标筛查，包括吸烟中断、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，复发的风险在戒烟后的前两周最为严重。因此，我们建议比较两种模型的时间和频率的IVR筛选。在技术增强型戒烟热线（TEQ）组中，戒烟后8周内将以递减频率拨打10次主动IVR电话（前两周每周两次，然后每周一次）。在高强度技术增强型戒烟热线（HI-TEQ）组中，将在戒烟后8周内拨打20次主动IVR电话（前2周每天一次，然后每周一次）。这项研究是一项随机对照试验，旨在比较戒烟热线计划参与者在6个月和12个月时的戒烟率和成本效益。将比较三个治疗组，即（1）标准戒烟终身护理，（2）IVR监测吸烟复发风险联合基于电话的戒烟治疗服务（TEQ），以及（3）高频监测吸烟复发风险联合基于电话的戒烟治疗服务（HI-TEQ）。受试者将从Free & Clear Quit for Life电话戒烟治疗计划的三个大客户（两个雇主和一个健康计划客户）中招募。如果成功的话，这种干预措施可以被纳入现有的戒烟方案，并提供给数百万试图戒烟的人，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.