Delivery of a Smoking Cessation Induction Intervention Via Virtual Reality Headset During a Dental Cleaning

吸烟率在一般人口中为15.5%，但在低收入人群中超过30 和低教育。这些吸烟者不太可能主动寻求戒烟咨询，而且 可能曾经使用过循证治疗（EBT，咨询和药物）戒烟。 因此，主动接触吸烟者非常重要。研究支持吸烟的有效性 牙科环境中的戒烟咨询。然而，一致实施的障碍包括提供商缺乏 时间，培训和经验咨询吸烟者谁是没有动机戒烟。使用技术可以 提供一种具有成本效益和时间效益的方式，在牙科中提供基于证据的戒烟 具有高度治疗保真度的设置。因为有效的戒烟计划已经存在， 需要创新来推动吸烟者参与EBT。我们的试点研究开发并测试了一个视频- 通过虚拟现实（VR）耳机提供基于戒烟诱导干预，而患者 正在进行牙齿清洁。城市牙科诊所的患者（n=23）戴着VR头盔观看10- 一分钟的戒烟诱导视频在他们的牙齿清洁（没有拍摄在VR由于潜在的 干预临床护理）。我们证明了患者的满意度，可行性，对介质的影响， 干扰临床护理。一个月后，5/23例患者报告戒烟，14/23例报告 放弃尝试。UH 3第3阶段随机疗效试验的主要目的是检验上述 干预增加了EBT的利用率（戒烟热线、基于诊所的计划、NCI短信计划、NRT或 其他戒烟药物）。受试者（n=376）为吸烟者 在一家主要为服务不足的病人服务的城市牙科诊所， 参与者将随机接受VR干预，包括：1）基于视频的干预 2）关于EBT的小册子，以及3）一个月的短信， 激励参与EBT;或对照组，包括观看放松的对照视频 技术通过VR头戴式耳机（以保持提供者掩蔽）在牙齿清洁和接收 和虚拟现实小组一样的EBT手册两组都将接受每周短信评估， 一个月后，牙科预约，以评估调解员。我们将客观地衡量戒烟热线的利用率， 短信程序和诊所程序。次要结果是戒烟的治疗效果 尝试，生物化学验证的禁欲，和戒烟的动机。我们还将评估主持人。 评估将在基线时进行，在预约后每周进行一次，持续一个月（通过文本）， 预约，3个月和6个月后。在UH 3之前，UG 3阶段将涉及最终确定 干预，可用性研究，提供者访谈，研究之间的无缝过渡 干预和EBT，措施的最后确定，对调解人的影响，以及满意度/可接受性数据。

The prevalence of smoking is 15.5% in the general population, but exceeds 30% among those with low income and low education. These smokers are less likely to proactively seek smoking cessation counseling, and less likely to have ever used evidenced-based treatment (EBTs, counseling and medications) for quitting smoking. Therefore, it is important to proactively reach smokers. Research supports the effectiveness of smoking cessation counseling in dental settings. However, barriers to consistent implementation include provider lack of time, training, and experience counseling smokers who are unmotivated to quit. Using technology could provide a cost-effective and time-efficient way of delivering evidenced-based smoking cessation in dental settings with a high degree of treatment fidelity. Because effective cessation programs already exist, innovations are needed to drive smokers to engage with EBTs. Our pilot study developed and tested a video- based smoking cessation induction intervention delivered through a Virtual Reality (VR) headset, while patients were undergoing teeth cleaning. Patients in an urban dental clinic (n=23) wore the VR headset to watch a 10- minute smoking cessation induction video during their teeth cleaning (not filmed in VR due to potential interference with clinical care). We demonstrated patient satisfaction, feasibility, impact on mediators, and no interference with clinical care. One month later, 5/23 patients reported smoking cessation, and 14/23 reported quit attempts. The primary aim of the UH3 Stage 3 randomized efficacy trial is to test whether the above intervention increases utilization of EBTs (Quitline, Clinic-based programs, NCI text message program, NRT or other smoking cessation medication) within 7-months post-appointment. Participants (n=376) will be smokers scheduled for a teeth cleaning at an urban dental clinic predominately serving underserved patients. Participants will be randomized to either the VR intervention, which consists of: 1) the video-based intervention via VR headset during their teeth cleaning, 2) brochure about EBTs, and 3) one month of text messages to motivate engagement with EBTs; or Control group, which consists of watching a control video on relaxation techniques through the VR headset (to maintain provider masking) during the teeth cleaning and receipt of the same EBT brochure as the VR group. Both groups will receive weekly text message assessments for one month after the dental appointment to assess mediators. We will objectively measure utilization of the Quitline, the text message programs, and clinic based programs. Secondary outcomes are treatment effects on quit attempts, biochemically verified abstinence, and motivation to quit. We will also assess moderators. Assessments will occur at baseline, weekly for one month after the appointment (via text), one month post- appointment, and 3 and 6 months later. Prior to UH3, the UG3 phase will involve finalization of the intervention, a usability study, provider interviews, creation of a seamless transition between the study intervention and EBTs, finalization of measures, impact on mediators, and satisfaction/acceptability data.