Optimizing remotely delivered Smoking Cessation Services for Low-Income Smokers

优化为低收入吸烟者提供的远程戒烟服务

• 批准号: 10215249
• 负责人: MICHAEL C FIORE
• 金额: $ 56.89万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10215249
• 关键词: Abstinence; Address; Biochemical; Cessation of life; Combined Modality Therapy; Complement; Counseling; Dissemination and Implementation; Effectiveness; Effectiveness of Interventions; Engineering; Enrollment; Evidence based intervention; Human Resources; Incentives; Income; Individual; Intervention; Intervention Studies; Logistics; Low Income Population; Low income; Malignant Neoplasms; Malignant neoplasm of lung; Mediator of activation protein; Medicaid; Outcome; PF4 Gene; Participant; Patient Self-Report; Pattern; Pharmaceutical Preparations; Policies; Population; Prevalence; Preventable cancer cause; Price; Randomized; Relapse; Reporting; Research; Resources; Rewards; Services; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Smoking History; System; Target Populations; Telephone; Testing; Text; Text Messaging; Time; Tobacco; Tobacco Use Cessation; Tobacco use; Translating; Uninsured; United States; Ursidae Family; Wisconsin; Work; burden of illness; cigarette smoking; comparison intervention; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; design; digital; disparity reduction; evidence base; experimental study; falls; financial incentive; flexibility; follow up assessment; follow-up; high risk population; improved; intervention effect; nicotine patch; nicotine replacement; preservation; prevent; primary outcome; programs; quality assurance; quitline; recruit; reduce tobacco use; remote delivery; response; smoking cessation; smoking intervention; smoking prevalence; smoking relapse; socioeconomic disadvantage; socioeconomic disparity; socioeconomics; success; tobacco-free; treatment effect; treatment response; treatment services

ABSTRACT Cigarette smoking is the leading preventable cause of cancer and many other deadly diseases, and the burden of tobacco use is greatest among those with limited socioeconomic resources. Although we have driven down population smoking rates, and with them, cancer rates, roughly 28% of the socioeconomically disadvantaged still smoke regularly. Low-income (L-I) smokers also develop cancer at higher rates and struggle more to quit than do higher-income smokers. These disparities in tobacco use and its burdens must be addressed. Highly effective cessation treatment services that can be delivered remotely, flexibly, and conveniently with few cost or logistical barriers have the potential to achieve this aim. Tobacco quitline and SmokefreeTXT services are such treatment resources with demonstrated attractiveness and reach among L-I smokers. The current proposal will use an efficient factorial design to evaluate 4 smoking cessation interventions with vast reach and dissemination potential. The target population will be N=1,408 Medicaid-eligible or uninsured smokers who have recently enrolled in the Wisconsin Tobacco Quit Line (WTQL), but who report continued smoking 4- months following engagement in standard WTQL services. These treatment non-responders will be invited to participate in an experiment that will randomize them to 1 of 2 levels of each of the following 4 factors in a 2X2X2X2 design: WTQL counseling intensity (1 session vs. 4 sessions), medication intensity (2-week nicotine patch monotherapy vs. 4-week nicotine patch and lozenge combination therapy), a supportive text messaging program (SmokefreeTXT vs. none), and financial incentives (rewards of up to $150 for treatment engagement vs. no treatment incentives). The primary outcome will be 26-week biochemically confirmed point-prevalence abstinence. Analyses will examine the main and interactive effects of these 4 treatment components on 26- week and secondary abstinence outcomes to identify the components and combinations of components that significantly enhance success in quitting in this high-risk population. This experiment will identify especially effective combinations of highly scalable interventions of modest cost and few barriers that could be disseminated nationally to reduce socioeconomic disparities in smoking cessation among those seeking to quit. Additional analyses will: compare intervention components and promising component combinations in terms of cost-effectiveness, examine whether or not treatment engagement differs across component combinations, examine baseline variables that may moderate treatment response, and identify mediators of treatment effects on abstinence outcomes. Because delivery of the study interventions can be centralized through established and efficient services (WTQL and SmokefreeTXT), the potential for both scalable dissemination and cost-effectiveness of the interventions tested is great. The proposed research will help identify ways to reduce tobacco cessation disparities in L-I smokers who have tried to quit smoking but relapsed and may benefit from improved assistance.

摘要 吸烟是癌症和许多其他致命疾病的主要可预防原因，也是 在社会经济资源有限的人群中，烟草使用率最高。尽管我们已经开到了 人口吸烟率，以及随之而来的癌症发病率，大约28%的社会经济弱势群体 仍然经常吸烟。低收入(L-I)吸烟者患癌症的几率也更高，戒烟的难度更大 比高收入的吸烟者更多。必须解决烟草使用及其负担方面的这些差异。高度 有效的戒烟治疗服务，可远程、灵活、方便地提供，且成本较低 或者，后勤障碍有可能实现这一目标。烟草戒烟热线和免费吸烟TXT服务是 这些治疗资源在L-I吸烟者中具有吸引力和覆盖面。海流 提案将使用有效的析因设计来评估覆盖范围广泛的4种戒烟干预措施 传播潜力。目标人群将是N=1,408名符合医疗补助资格或未参保的吸烟者 最近加入了威斯康星州戒烟热线(WTQL)，但报告继续吸烟的人有4- 在参与标准WTQL服务几个月后。这些治疗无效的人将被邀请到 参与一项实验，将他们随机分成以下4个因素中每个因素的2个水平之一 2X2X2X2设计：WTQL咨询强度(1次与4次)，用药强度(2周尼古丁 贴片单一疗法与四周尼古丁贴片和含片联合疗法)，支持性短信 计划(免费TXT与无)和经济奖励(参与治疗最高可获得150美元奖励) 与没有治疗激励措施相比)。主要结果将是生化确诊的26周点流行率。 禁欲。分析将考察这4个治疗成分对26- 一周和二次戒断结果，以确定以下成分及其组合 在这一高危人群中显著提高戒烟成功率。这项实验将特别地识别 成本适中、障碍少、高度可扩展的干预措施的有效组合 在全国范围内传播，以减少寻求戒烟的人在社会经济方面的差距 不干了。其他分析将：比较干预组件和有希望的组件组合 在成本效益方面，检查不同组件的治疗参与度是否不同 组合，检查可能缓和治疗反应的基线变量，并确定 治疗对禁欲结果的影响。因为研究干预措施的交付可以集中进行 通过建立和高效的服务(WTQL和SmokeFree TXT)，两者的潜力都是可扩展的 所测试的干预措施的传播和成本效益都很高。拟议中的研究将有所帮助 找出减少L吸烟者戒烟差距的方法--吸烟者曾试图戒烟但 复发，并可能受益于更好的援助。