Developing a Smoking Cessation Intervention for Methadone Maintained Smokers

描述(申请人提供)：接受美沙酮维持治疗的滥用药物者中，超过75%为吸烟者。与普通人群相比，美沙酮患者不成比例地遭受吸烟的身体后果，包括死亡率增加。然而，接受美沙酮治疗的吸烟者对戒烟和接受戒烟治疗感兴趣，戒烟的药物滥用吸烟者使用药物的可能性较小。关于美沙酮患者戒烟干预的少数研究表明，在治疗期间和治疗后立即烟草使用显著减少；然而，戒烟者的百分比很小，几乎所有戒烟者都迅速恢复吸烟。此外，所研究的干预措施很简单，并模仿了可能没有考虑到吸毒者复杂需求的一般人口指南。为了更好地帮助美沙酮维持吸烟者戒烟和保持戒烟状态，我们提议进行一项研究，目的如下：(1)确定戒烟治疗的结构和要素，以帮助美沙酮维持吸烟者戒烟并保持长期戒烟；(2)制定针对美沙酮维持吸烟者的量身定制的强化戒烟干预手册；以及(3)在一项小型随机对照试验中试点和评估针对美沙酮维持吸烟者的量身定制的强化戒烟干预的即刻和长期效果。这项研究将包括两个项目。项目一将针对目标1，并涉及通过美沙酮诊所临床工作人员和接受美沙酮维持治疗的现任和以前吸烟者的焦点小组收集定性数据。从项目一收集的数据将为项目二提供信息，以便在一项小型随机对照临床试验中为美沙酮维持吸烟者开发和试点一种量身定制的强化戒烟干预措施(目标2和3)。我的目标是成为一名独立的临床调查员，在戒烟、定性和定量研究方法以及行为干预开发方面拥有专业知识。我建议的职业发展计划包括指导和结构化课程：(1)定性研究方法和数据分析；(2)行为干预发展和戒烟方法；(3)进行随机临床试验的方法和后勤；(4)烟草使用的流行病学；(5)先进的定量统计方法；以及(6)负责任的研究工作。此外，我还将参加地方研讨会和国家科学会议。 公共卫生相关性：减少烟草使用和增加成人戒烟尝试是2010年健康人的目标，确定针对有共同危险行为的人的干预措施的有效性被确定为国家卫生研究院关于烟草使用的国家科学会议声明中的优先事项。我们希望通过开发、评估和新的戒烟干预措施，帮助美沙酮维持吸烟者戒烟和维持烟草戒断。

DESCRIPTION (provided by applicant): Over 75% of drug abusers receiving methadone maintenance treatment are tobacco smokers. Methadone patients disproportionately suffer from the physical consequences of smoking, including increased mortality, compared to the general population. Yet, smokers receiving methadone treatment are interested in quitting and receiving tobacco cessation treatment, and drug abusing smokers who quit smoking are less likely to use drugs. The few studies of smoking cessation interventions in methadone patients have shown significant reductions in tobacco use during and immediately after treatment; however, the percentages of individuals who quit smoking were small and nearly all those who quit quickly returned to smoking. In addition, the interventions studied were simple and modeled after guidelines for the general population that may not have accounted for the complex needs of drug abusers. To better help methadone maintained smokers quit smoking and maintain tobacco abstinence, we propose a study with the following aims: (1) to determine the structure and elements of smoking cessation treatment that will help methadone maintained smokers quit smoking and maintain long-term tobacco abstinence; (2) to develop a manual for a tailored, intensive smoking cessation intervention for methadone maintained smokers; and (3) to pilot and evaluate in a small randomized controlled trial the immediate and long-term effects of a tailored, intensive smoking cessation intervention for methadone maintained smokers. This study will consist of two projects. Project One will address Aim 1 and involve collecting qualitative data through focus groups with methadone clinic clinical staff and current and previous smokers receiving methadone maintenance treatment. The data collected from Project One will inform Project Two, to develop and pilot in a small randomized controlled clinical trial a tailored, intensive smoking cessation intervention for methadone maintained smokers (Aims 2 and 3). My goal is to become an independent clinical investigator with expertise in smoking cessation, qualitative and quantitative research methods, and behavioral intervention development. The Career Development Plan I have proposed includes mentorship and structured coursework in: (1) qualitative research methods and data analyses; (2) behavioral intervention development and methods for smoking cessation; (3) methodology and logistics of conducting randomized clinical trials; (4) epidemiology of tobacco use; (5) advanced quantitative statistical methods; and (6) responsible conduct of research. In addition, I will participate in local seminars and national scientific meetings. PUBLIC HEALTH RELEVANCE: Reducing tobacco use and increasing smoking cessation attempts among adults are objectives of Healthy People 2010, and determining the effectiveness of interventions targeting persons with co- occurring risk behaviors was identified as a priority in the National Institutes of Health State-of-the- Science Conference Statement on Tobacco Use. We hope to help methadone maintained smokers quit smoking and maintain tobacco abstinence by developing and evaluating and new smoking cessation intervention.