Mobile contingency management for smoking cessation in returning US Veterans

回国退伍军人戒烟的移动应急管理

• 批准号: 9208126
• 负责人: PATRICK S. CALHOUN
• 金额: $ 40.85万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-01 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9208126
• 关键词: Abstinence; Afghanistan; Alcohol abuse; Attention; Behavior Therapy; Behavioral; Bypass; Carbon Monoxide; Caring; Cellular Phone; Centers for Disease Control and Prevention (U.S.); Cessation of life; Cigarette; Clinic; Cognitive; Cognitive Therapy; Counseling; Data; Data Analyses; Development; Drug usage; Effectiveness; Evaluation; Evidence based treatment; Freedom; Geography; Goals; Guidelines; Health Technology; Health behavior change; Healthcare; Individual; Inpatients; Intervention; Iraq; Measures; Mediating; Mediator of activation protein; Mental Depression; Military Personnel; Monitor; Morbidity - disease rate; Outpatients; Participant; Patient Self-Report; Pharmaceutical Preparations; Population; Populations at Risk; Positive Reinforcer; Post-Traumatic Stress Disorders; Process; Quality-Adjusted Life Years; Randomized; Research; Risk; Sampling; Secure; Self Efficacy; Services; Smoker; Smoking; Smoking Cessation Intervention; Smoking History; Substance Use Disorder; Telemedicine; Telephone; Testing; Time; Tobacco use; Treatment outcome; United States; United States National Institutes of Health; Veterans; War; Withholding Treatment; base; cigarette smoking; cohort; comparative effectiveness; compare effectiveness; contingency management; cost effective; cost effectiveness; design; disability; disorder prevention; drug abstinence; effectiveness trial; evidence base; follow-up; high risk; incremental cost-effectiveness; innovation; mHealth; medical specialties; medication compliance; mortality; nicotine replacement; novel strategies; operation; pain symptom; portability; prevent; programs; psychiatric symptom; public health relevance; relative cost; smoking cessation; smoking intervention; substance misuse; telehealth; therapy design; treatment duration; treatment program; voucher

DESCRIPTION (provided by applicant): Despite recent efforts to expand reach of smoking cessation treatment options beyond clinic based care, smoking cessation treatment including the use of smoking cessation aids remain greatly underutilized. If cessation programs are to have significant impact (Impact = Reach X Efficacy) on changing health behavior at the population level, there is a fundamental need to develop new and innovative strategies to increase treatment intensity, access, and participation. The use of intensive behavioral therapies, such as contingency management (CM), have demonstrated efficacy for reducing smoking in difficult-to-treat populations, but have had limited reach given the need to verify abstinence multiple times daily via clinic based monitoring. The development of a mobile health (mHealth) platform to provide CM has made the use of intensive CM approaches portable and feasible. The primary goal of the current study is to evaluate the effectiveness of a proactive tele-health intervention that combines evidenced based treatment for smoking cessation with smart- phone based, portable contingency management on smoking rates. The central hypothesis is that increasing the intensity of available tele-health smoking approaches through the addition of mobile CM will be an effective way to reduce smoking rates in Veterans returning from the Iraq/Afghanistan wars. Guided by strong preliminary data, this hypothesis will be tested in a comparative effectiveness trial with a two-group design in which 260 Veteran smokers will be randomized to receive either a "mCM" intervention which combines evidenced based cognitive-behavioral telephone counseling (TC), a tele-medicine clinic for access to nicotine replacement (NRT), and mCM administered through a smart phone or to a control condition that will provide controls for therapist, medication, time and attention effects. Specific aims are to evaluate (1) the impact of mCM on rates of abstinence from cigarettes as measured by bio-verified, self-reported prolonged abstinence at 3-month, 6-month, and 12 month post-randomization follow-up, (2) the relative cost-effectiveness of the mCM intervention in quality adjusted life years (QALY), and (3) potential treatment mediators including self-efficacy and treatment process mechanisms. The approach is innovative because it builds upon advances in mHealth technology and will be the first evaluation of smart phone based mobile CM in conjunction with other evidence- based smoking cessation treatment for OEF/OIF/OND Veterans. There is a surprising lack of research aimed at evaluating multi-component smoking cessation interventions that integrate CM with evidence-based cognitive-behavioral treatment and smoking cessation aids such as NRT. Cigarette smoking remains the most lethal substance use disorder in the United States and military veterans are at particular high risk for smoking related morbidity and mortality. The significance of identifying cost-effective approaches to decreasing tobacco use in the relatively young and at-risk cohort of returning Veterans could be tremendous as it will prevent significant morbidity and mortality.

描述（由申请人提供）：尽管最近努力将戒烟治疗方案扩展到诊所护理之外，但戒烟治疗包括戒烟辅助工具的使用仍未得到充分利用。如果戒烟计划要对改变人群的健康行为产生重大影响（影响=达到X功效），就需要制定新的创新战略，以增加治疗强度、可及性和参与度。使用强化行为疗法，如应急管理（CM），已经证明在难以治疗的人群中减少吸烟的有效性，但由于需要通过基于诊所的监测每天多次核实戒烟情况，其影响有限。提供CM的移动医疗（mHealth）平台的发展使得密集CM方法的使用变得便携和可行。本研究的主要目的是评估主动远程医疗干预的有效性，该干预将基于证据的戒烟治疗与基于智能手机的便携式吸烟率应急管理相结合。中心假设是，通过增加移动医疗中心，增加可用的远程保健吸烟方法的强度，将是减少从伊拉克/阿富汗战争归来的退伍军人吸烟率的有效方法。在强有力的初步数据的指导下，这一假设将在两组设计的比较有效性试验中得到检验，其中260名资深吸烟者将随机接受“mCM”干预，该干预结合了基于证据的认知行为电话咨询（TC），远程医疗诊所获得尼古丁替代品（NRT）， mCM通过智能手机管理或控制条件，将为治疗师，药物，时间和注意力效应。具体目的是评估(1)mCM对戒烟率的影响，通过随机化随访后3个月、6个月和12个月的生物验证、自我报告的延长戒烟时间来衡量；(2)mCM干预在质量调整生命年（QALY）中的相对成本效益；(3)潜在的治疗介质，包括自我效能和治疗过程机制。这种方法是创新的，因为它建立在移动医疗技术的进步之上，并且将是基于智能手机的移动CM与OEF/OIF/OND退伍军人的其他基于证据的戒烟治疗相结合的第一次评估。令人惊讶的是，缺乏旨在评估多成分戒烟干预措施的研究，这些干预措施将CM与基于证据的认知行为治疗和戒烟辅助手段（如NRT）结合起来。吸烟仍然是美国最致命的物质使用障碍，退伍军人与吸烟相关的发病率和死亡率尤其高。确定具有成本效益的方法来减少相对年轻和有风险的退伍军人群体的烟草使用，其意义可能是巨大的，因为它将防止显著的发病率和死亡率。