Enhancing the Efficacy of a Smoking Quit Line in the Military

描述（由申请人提供）：在吸烟干预文献中，最广泛采用和传播的干预措施之一是电话戒烟热线（ql）。虽然ql是有效的，但戒烟率适中，复发很明显。到目前为止，还没有研究评估重新吸引那些戒烟失败或复发的ql吸烟者的方法。我们对服务于所有50个州的QL的调查显示，QL鼓励那些复发或未能在目标戒烟日期戒烟的人重新参与两种方法中的一种：(1)重新启动整个QL干预（循环）；(2)减少每天吸烟的数量（即降低吸烟率），最终目标是戒烟。尽管这些再接触干预措施被广泛使用，但没有经验证据支持这些治疗再接触策略在烟草QLs中的应用。这个应用程序的重点是扩展我们的研究与我们的验证烟草QL在军事。我们的理由包括这样一个事实，即军事人员是美国香烟使用率最高的现役军事人员，他们吸烟的风险很高，但却代表了一个服务不足的人群。现役军人的吸烟率从26%到40%不等，这取决于服役部门。在减少军队烟草使用方面存在着独特的挑战，包括人员流动性高、地点偏远和获得保健服务的机会有限。许多在平民人群中有效的戒烟计划在军事人群中评估时并不显示出有效性。在我们之前的资助期间，我们已经记录了我们的军事定制QL与极高的持续戒烟率相关。与被动QL相比，我们的军事主动QL在一年的随访中产生了更高的戒烟率。但与民用QL相似，我们观察到从治疗结束到一年随访期间持续戒烟率明显下降。在QL治疗结束时，复发或未能戒烟的吸烟者有机会重新参与。如上所述，民用垃圾填埋场使用回收和降低费率作为处理再接触的主要方法。不幸的是，这些重新与复发/未能戒烟的吸烟者接触的方法尚未得到系统的评估。因此，我们建议将在干预结束时复发或未能戒烟的参与者随机分配到：(1)重复主动QL（循环）；(2)减少吸烟，以最终戒烟为目标（降低吸烟率）；或(3)选择回收或降低费率（选择）。在12个月的随访中，通过评估点患病率和持续禁欲来确定疗效。虽然需要针对军队进行最终传播，但我们的研究结果应该可以推广到所有烟草QL。

DESCRIPTION (provided by applicant): In the cigarette smoking intervention literature, one of the most widely adopted and disseminated interventions are telephone tobacco quit lines (QLs).While QLs are efficacious, cessation rates are modest and relapse is marked. To date, no studies have evaluated methods of re-engaging smokers who call QLs that either fail to quit smoking or relapse. Our survey of QLs serving all 50 states revealed that QLs encourage one of two methods for reengagement for those that have relapsed or who failed to quit on their target quit date: (1) Re- initiate the entire QL intervention (Recycle); or (2) reduce the number of cigarettes per day (i.e., Rate Reduction) with the ultimate goal of quitting. Despite widespread use of these reengagement interventions, no empirical evidence exists supporting either these treatment reengagement strategies in tobacco QLs. The focus of this application is to extend our research with our validated tobacco QL in the military. Our rationale includes the fact that military personnel have among the highest rates of cigarette use in the U.S. Active duty military personnel are at high risk for smoking, but represent an underserved population. Smoking rates among active duty personnel range from 26% to 40%, depending on the service branch. Unique challenges to reducing tobacco use in the military exist, including high personnel mobility, remote locations, and limited healthcare service access. Many efficacious stop-smoking programs in civilian populations do not demonstrate efficacy when evaluated in a military population. In our previous funding period, we have documented that our military-tailored QL was associated with extremely high rates of sustained smoking cessation. Our military proactive QL produced superior cessation rates at a one year follow-up compared to a reactive QL. But similar to civilian QLs, we observed marked decay of sustained cessation rates from the end of treatment to the one year follow-up. An opportunity exists to reengage smokers who relapse or fail to quit by the end of QL treatment. As mentioned above, civilian QLs use Recycling and Rate Reduction as the primary method for treatment reengagement. Unfortunately these methods of reengaging the relapsed/failed to quit smoker have not been systematically evaluated. As such, we propose to randomize participants who relapse or fail to quit by the end of the intervention to either (1) repeating the proactive QL (Recycle); (2) smoking reduction with the goal of eventual cessation (Rate Reduction); or (3) the choice of Recycle or Rate Reduction (Choice). Efficacy will be established by assessing both point prevalence and continuous abstinence at a 12 month follow-up. While QL targeted to the military for ultimate dissemination is needed, our findings should be nonetheless generalizable to all tobacco QLs.