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A Scalable e-Health Smoking Cessation Intervention for Socioeconomically Disadvantaged Veterans

针对社会经济弱势退伍军人的可扩展电子健康戒烟干预措施

基本信息

批准号：
9912129
负责人：
Jaimee Heffner
金额：
$ 20.24万
依托单位：
FRED HUTCHINSON CANCER RESEARCH CENTER
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-09 至 2022-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9912129
关键词：
Abstinence Address Attention Awareness Behavior Therapy Benchmarking Biochemical Cancer Etiology Caring Cigarette Smoker Control Groups Counseling Development Disabled Persons Disease Effectiveness Female General Population Goals Health High Prevalence Home environment Integrated Health Care Systems Internet Intervention Low income Maintenance Measures Methodology Military Personnel Minority Modeling Motivation Online Systems Outcome Participant Patient Self-Report Phase Pilot Projects Population Positioning Attribute Practice Guidelines Process Public Health Readiness Relapse Resources Risk Science Services Smoker Smoking Smoking Cessation Intervention Testing Therapeutic Intervention Tobacco Tobacco Use Cessation Tobacco-Related Carcinoma Treatment Efficacy United States Public Health Service Veterans Waiting Lists base cigarette smoking coping cost cost effectiveness craving design digital eHealth feasibility trial handheld mobile device health administration health care settings health disparity improved innovation interest male natural language novel novel strategies preference programs randomized trial satisfaction scale up smoking cessation smoking prevalence socioeconomic disadvantage standard care success theories tool usability virtual coach virtual human web site young adult

项目摘要

PROJECT SUMMARY Although cigarette smoking rates have declined in the US over the past 50 years, there has been an upturn in smoking among military personnel in the last several decades. With over 8 million Veteran enrollees, the Veterans Health Administration serves 75% of low-income and disabled Veterans. Less than 5% of Veterans receiving care through VHA access intensive treatment for smoking cessation, and these services employ a standard approach to cessation counseling that is most relevant for smokers who are ready to quit. To optimize acceptability, reach, and effectiveness, cessation treatments for Veteran smokers should be appropriate for all levels of readiness to quit. A web-based Acceptance and Commitment Therapy program, Flexiquit, has shown great promise in increasing quit rates for smokers in all stages of readiness to quit (52% vs. 14% in a wait-list control group). Web-based delivery makes the program readily scalable to the population level. In this study, we propose development and pilot testing of Vet Flexiquit, an adaptation of Flexiquit for US Veteran cigarette smokers. The study will be conducted in two phases. The first phase will consist of adaptation and iterative usability testing with low-income Veteran smokers (n=20). The second phase will be a pilot feasibility trial (n=50) comparing Vet Flexiquit to the SmokefreeVET web site. The primary goals of the pilot study are to compare Vet Flexiquit to SmokefreeVET on acceptability (i.e., user satisfaction and number of log-ins) and efficacy for impacting theory-based change processes and promoting smoking cessation. This pilot project is significant and innovative in four key respects: (1) it addresses the top cause of cancer and other preventable diseases among socioeconomically disadvantaged US Veterans served by VHA, (2) it applies a novel treatment approach and advances the science of ACT for smoking cessation by testing its effectiveness for smokers at all stages of readiness to quit rather than only among smokers who are ready to quit, (3) web- based delivery has high potential reach, cost-effectiveness, and scalability within VHA, a health care setting where tobacco cessation is under-resourced; and (4) gamification and inclusion of virtual coaches as engagement strategies are substantially different than standard web-based tobacco treatments, including SmokefreeVET. If found to be effective in a larger trial, Vet Flexiquit would be well-positioned for VHA-wide scale-up due to its low maintenance cost and high potential reach, and the core program could be built upon in innovative ways (e.g., capability for virtual coaches to understand and respond to natural language) to further improve engagement and outcomes.

项目总结尽管美国的吸烟率在过去50年里有所下降，但在过去的50年里，在过去的几十年里，军事人员中有吸烟的人。有超过800万的资深注册人员，退伍军人健康管理局为75%的低收入和残疾退伍军人提供服务。不到5%的退伍军人通过VHA Access接受戒烟强化治疗，这些服务雇用戒烟咨询的标准方法，这是最相关的吸烟者谁准备戒烟。要优化可接受性、可及性和有效性，戒烟治疗应该适用于所有人戒烟的准备程度。一个基于网络的接受和承诺治疗项目Flexiquit已经显示极有希望提高处于戒烟准备各个阶段的吸烟者的戒烟率(52%比14%在等待名单上对照组)。基于Web的交付使该计划可以很容易地扩展到人口水平。在这项研究中，我们建议开发和中试Vet Flexiquit，这是一种适用于美国老牌卷烟的Flexiquit 吸烟者。研究将分两个阶段进行。第一阶段将包括适应和迭代对低收入的资深吸烟者(n=20)进行可用性测试。第二阶段将是试点可行性试验。 (n=50)将Vet Flexiquit与SmokeFree VET网站进行比较。试点研究的主要目标是比较Vet Flexiquit和SmokefreVET在可接受性(即用户满意度和登录次数)和影响基于理论的改变过程和促进戒烟的有效性。这一试点项目是在四个关键方面具有重大意义和创新：(1)它解决了癌症和其他可预防的疾病的首要原因 VHA服务的社会经济弱势美国退伍军人中的疾病，(2)它应用了一种新的通过测试ACT对戒烟的有效性，促进了ACT戒烟的科学性准备戒烟的所有阶段的吸烟者，而不仅仅是准备戒烟的吸烟者，(3)网络- 在VHA这一医疗保健环境中，基于服务的交付具有很高的潜在覆盖面、成本效益和可扩展性在戒烟资源不足的情况下；以及(4)将虚拟教练游戏化和纳入为参与策略与标准的基于网络的烟草治疗有很大不同，包括无烟兽医。如果在更大的试验中被发现有效，Vet Flexiquit将在VHA范围内处于有利地位由于其低维护成本和高潜在覆盖范围而进行扩展，并且核心计划可以在创新的方式(例如，虚拟教练理解和回应自然语言的能力)以进一步提高参与度和成果。