Preventing Lung Cancer through Tobacco Cessation at FDNY

项目摘要/摘要 在任何年龄戒烟都有显著的健康益处，而不仅仅是公认的 对癌症的影响。纽约市消防局(FDNY)世界贸易中心健康计划 (WTCHP)位于其职业健康诊所内。参加FDNY WTCHP低剂量试验的所有参与者 计算机断层扫描(LDCT)肺癌筛查计划可免费戒烟 计划(通常是戒烟咨询加尼古丁替代治疗)。虽然许多人现在都是以前的 吸烟者中，36%的LDCT项目参与者继续吸烟。需要新的战略来参与 继续吸烟的WTCHP成员纳入循证戒烟治疗。在建议的 试验中，参加FDNY WTCHP LDCT筛查计划的人将从FDNY退休 随机接受标准护理：一封关于LDCT筛查和免费FDNY的信 戒烟计划包括Varenicline治疗和通过远程医疗或 加强护理：一封信，通知他们将参加FDNY戒烟计划 除非他们选择退出，否则类似于获得varenicline治疗，但加上个性化的远程医疗 与我们的烟草治疗专家会面，使用此人的最新LDCT结果进行个性化 戒烟信息。所有参与者都将接受varenicline“预负荷”，即在治疗前四周。 他们的目标戒烟日期之后是12周的治疗，这种方法被证明可以减少戒烟前的烟草- 相关奖励。这一增强护理方法的每个基本要素：选择退出登记和 与LDCT结果相关联的个性化生物反馈已被证明在其他环境中有效。1-5这 方案是第一个在随机试验中将这些元素加上varenicline治疗与预加载相结合的方案 有以下两种情况之一的高危吸烟者(定义为符合LDCT筛查标准的吸烟者加上WTC暴露 未登记戒烟或在标准护理计划下之前的戒烟尝试中未成功。我们 假设FDNY增强护理计划将与增加的参保人数和 与标准护理相比，烟草治疗结果的比率更高。 具体目标1：比较登记人数(参加我们的烟草治疗专家的第一次访问) FDNY标准护理与强化护理方法的戒烟计划。 具体目标1a：评估与FDNY烟草有关的人口学和临床特征 戒烟计划注册。 具体目标2：比较结果(保留到研究结束日期、varenicline和咨询依从性和 标准护理与强化护理方法在FDNY戒烟计划中的戒烟率)。 具体目标2a：评估与烟草有关的人口学和临床特征 治疗结果。

Project Summary/Abstract Quitting smoking at any age can have significant health benefits which extend beyond its well-recognized impact on cancer. The Fire Department of the City of New York (FDNY) World Trade Center Health Program (WTCHP) is situated within its occupational health clinics. All participants in the FDNY WTCHP low dose computed tomography (LDCT) lung cancer screening program have access to a free, tobacco cessation program (typically cessation counseling plus nicotine replacement treatment). While many are now former smokers, 36% of LDCT program participants continue to smoke. Novel strategies are needed to engage WTCHP members who continue to smoke into evidence-based smoking cessation treatment. In the proposed trial, participants in the FDNY WTCHP LDCT screening program who are retired from FDNY will be randomized to receive Standard Care: a letter with information about LDCT screening and the free FDNY Tobacco Cessation program including varenicline treatment and cessation counselling via telemedicine or Enhanced Care: a letter informing them that they will be enrolled in the FDNY Tobacco Cessation Program unless they opt-out, similar access to varenicline treatment, but coupled with individually-tailored telemedicine sessions with our tobacco treatment specialist using that person’s most recent LDCT results to personalize cessation messaging. All participants will receive varenicline “preloading,” i.e., four weeks of treatment prior to their target quit date followed by 12 weeks of treatment, an approach shown to decrease pre-quit tobacco- associated reward. Each of the essential elements of this Enhanced Care method: opt-out enrollment and individually-tailored biofeedback linked to LDCT results has been shown to be effective in other settings.1-5 This protocol is the first to combine these elements plus varenicline treatment with preloading in a randomized trial of high-risk smokers (defined as those meeting LDCT screening criteria plus WTC exposure) who have either not enrolled in tobacco cessation or not succeeded in previous quit attempts under Standard Care. We hypothesize that the FDNY Enhanced Care Program will be associated with both increased enrollment and improved rates of tobacco treatment outcomes compared with Standard Care. Specific Aim 1: To compare enrollment (participation in a first visit with our tobacco treatment specialist) in the FDNY Tobacco Cessation Program by Standard Care vs. Enhanced Care methods. Specific aim 1a: To evaluate demographic and clinical characteristics associated with FDNY Tobacco Cessation Program enrollment. Specific Aim 2: To compare outcomes (retention to study end-date, varenicline and counseling adherence and tobacco quit rates) in the FDNY Tobacco Cessation Program by Standard Care vs. Enhanced Care methods. Specific Aim 2a: To evaluate demographic and clinical characteristics associated with tobacco treatment outcomes.