Expanding population-level interventions to help more low-income smokers quit

扩大人口干预措施，帮助更多低收入吸烟者戒烟

• 批准号: 9817234
• 负责人: MATTHEW W. KREUTER
• 金额: $ 66.06万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-23 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9817234
• 关键词: Abstinence; Adult; American; Belief; Biochemical; Contracts; Costs and Benefits; Counseling; Data; Economics; Education; Effectiveness; Eligibility Determination; Environmental Tobacco Smoke; Evidence based practice; Exposure to; Group Homes; Health Care Costs; Home environment; Hour; Human; Hybrids; Intervention; Lead; Low Income Population; Low income; Malignant Neoplasms; Measures; Medicaid; Participant; Policies; Population; Poverty; Practical trial; Prevalence; Provider; Psychological Stress; Randomized; Readiness; Reporting; Research; Services; Smoke-free home; Smoker; Smoking; Societies; Subgroup; Telephone; Testing; Tobacco; Treatment Cost; Uninsured; base; cigarette smoke; cost effectiveness; design; economic cost; evidence base; follow-up; home smoking ban; non-smoker; policy implication; programs; quitline; randomized trial; recruit; service providers; smoking prevalence; treatment services

Abstract There is an urgent need to engage more low-income smokers in activities that lead to quitting. The current standard of practice for population-level tobacco treatment is phone-based cessation counseling delivered by state tobacco quitlines. But quitline services are restricted to smokers who are ready to quit in the next 30 days, a criterion met by only 20-30% of low-income smokers. Thus, current population level tobacco treatment has nothing to offer 70-80% of low-income U.S. smokers. Based on extensive preliminary research by our study team, we assert that offering a pre-cessation intervention – Smoke Free Homes – to low-income smokers who are not yet ready to quit will: (1) engage more smokers in using proven interventions; (2) increase their readiness to quit and quit attempts; (3) reduce the number of cigarettes they smoke per day; and (4) increase cessation. These benefits will accrue in addition to reducing exposure to harmful secondhand smoke for non-smokers in the home. In a Hybrid Type 2 randomized trial, 1,980 low-income smokers from nine states with high smoking prevalence will be recruited from 2-1-1 helplines to receive either current standard practice (Quitline) or expanded services (Quitline + Smoke Free Homes), both delivered by Optum, the largest U.S. quitline service provider. In the latter condition, smokers will be offered cessation counseling first, just like current standard practice, but those who decline will then be offered Smoke Free Homes. At 3-month follow- up, those in the latter condition who accepted quitline services but did not quit will be offered Smoke Free Homes, and those that accepted Smoke Free Homes but did not quit will be offered quitline services. The effectiveness portion of the Hybrid Type 2 design (Aim 1) will use intent-to-treat analyses to compare group differences at 3- and 6-month follow-up in 7- and 30-day point prevalence abstinence with biochemical verification, as well as 24-hour quit attempts and cigarettes smoked per day. The implementation portion of the Hybrid Type 2 design (Aims 2-3) will measure smokers’ acceptance and use of the interventions, as well as cost-effectiveness and cost-benefits of adding Smoke Free Homes to quitline services. With rates of smoking and smoking-related cancers much higher in low-income populations and treatment costs exceeding tens of billions of dollars annually in Medicaid alone, this large-scale practical trial will provide strong evidence with high external validity to answer an important policy question : Will changing the standard practice for population-level treatment of smoking result in increased cessation in low-income populations?

抽象的 迫切需要让更多的低收入吸烟者参与导致安静的活动。电流 人口级烟草治疗的实践标准是基于电话的戒烟咨询 状态烟草。但是戒烟服务仅限于准备在接下来的30中退出的吸烟者 天数，仅20％至30％的低收入吸烟者符合标准。那是当前的人口水平烟草治疗 没有什么可以提供70-80％的低收入美国吸烟者。基于我们的广泛初步研究 研究团队，我们断言，提供陈述前干预 - 无烟房屋 - 低收入 尚未准备好戒烟的吸烟者将：（1）吸烟者使用经过验证的干预措施； （2） 提高他们辞职和戒烟的愿望； （3）减少每天抽烟的数量；和 （4）增加停止。除了减少有害二手暴露外，这些好处还将接受 在家中的非吸烟者吸烟。在一项混合2型随机试验中，有1,980名低收入吸烟者 吸烟率高的州将从2-1-1求助热线招募，以接收任何当前标准 练习（Quitline）或扩展服务（Quitline +无烟房屋），均由最大的Optum提供 美国Quitline服务提供商。在以后的情况下，将首先提供吸烟者的戒烟咨询，就像 当前的标准练习，但是那些拒绝的人将获得无烟的房屋。在3个月的后续 向上，那些接受戒烟服务但没有退出的情况的人将免费提供烟雾 房屋，以及那些接受无烟房屋但不退出的房屋将获得戒烟服务。这 混合2型设计（AIM 1）的有效性部分将使用意图对治疗分析来比较组 在7天和30天的生化频率中，在3个月和6个月的随访中的差异 验证，以及每天抽烟的24小时戒烟和香烟。实施部分 混合2型设计（目标2-3）将衡量吸烟者对干预措施的接受和使用，以及 成本效益和为戒烟服务增加无烟房屋的成本效益。吸烟率 在低收入人群中，与吸烟有关的癌症高得多 仅在医疗补助中，每年数十亿美元，这项大规模实践试验将提供有力的证据 很高的外部有效性回答一个重要的政策问题：将改变标准做法 人口水平的吸烟治疗导致低收入人群停止增加？