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（QLs）。虽然QLs有效，但戒烟率适中，复发率明显。到目前为止，还没有研究评估重新吸引吸烟者的方法，这些吸烟者称之为未能戒烟或复吸的QLs。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的两种方法之一：（1）重新启动整个QL干预（回收）;或（2）减少每天吸烟的数量（即，降低利率），最终目标是戒烟。尽管广泛使用这些再参与干预措施，没有经验证据支持烟草QLs中的这些治疗再参与策略。 该应用的重点是在军事上使用我们经过验证的烟草QL扩展我们的研究。我们的理由包括军事人员是美国吸烟率最高的人之一，现役军事人员吸烟的风险很高，但代表了一个服务不足的群体。现役人员的吸烟率从26%到40%不等，这取决于服务分支。在军队中减少烟草使用存在独特的挑战，包括人员流动性高，位置偏远，医疗服务有限。许多在平民中有效的戒烟计划在军事人群中进行评估时并没有表现出有效性。 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。与反应性QL相比，我们的军事主动QL在一年随访时产生了更高的上级戒烟率。但与平民QLs相似，我们观察到从治疗结束到一年随访的持续戒烟率明显下降。 对于在QL治疗结束时复发或未能戒烟的吸烟者，存在重新参与的机会。如上所述，民用QLs使用回收和速率降低作为治疗再参与的主要方法。不幸的是，这些重新吸引复发/未能戒烟的吸烟者的方法尚未进行系统评估。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（再循环）;（2）减少吸烟，最终戒烟（减少吸烟率）;或（3）选择再循环或减少吸烟率（选择）。将通过评估12个月随访时的时点患病率和持续戒烟率来确定疗效。 虽然QL针对最终传播的军事是必要的，我们的研究结果应该是普遍适用于所有烟草的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.