A Text Messaging Intervention for Smoking Cessation Among Community Health Center Patients

 描述(申请人提供)：在过去的十年里，美国的戒烟率几乎没有变化。显然，戒烟需要新的干预措施。短信已经被认为是一种很有前途的戒烟支持方式。现有的研究几乎没有研究将短信戒烟干预整合到医疗系统中的模型。鉴于每年有70%的吸烟者去看医生，医疗保健系统是提供戒烟支持的重要场所。将服务集成到医疗保健中，可以协调行为和药物干预，并利用患者与提供者的关系。戒烟药物依从性差被认为限制了它们的有效性。短信已经被用来促进其他情况下的药物依从性，但利用短信来促进戒烟药物的研究还不够深入。拟议的科学计划有两个研究目标：(1)在社区卫生中心对吸烟者(n=30)进行定性焦点小组，以评估他们对来自医疗保健提供者的短信的偏好，并探索他们使用尼古丁替代疗法的经验和药物依从性障碍，以便为短信干预的设计提供信息；(2)在一项试点随机对照试验(N=106)中，测试通过短信提供药物疗法支持的行为戒烟内容和尼古丁替代疗法对自我报告的戒烟尝试(故意不吸烟=24小时)、药物治疗的依从性和治疗结束时生化确认的戒烟的影响。首席调查员(PI)提出了一项职业发展计划，其中包括方法学培训和哈佛大学教师的指导，以设计和评估针对社区卫生中心吸烟者的短信干预。该职业发展奖的长期目标是将Gina Kruse M.D.，M.S.，M.P.H.发展成为一名独立的戒烟研究人员，拥有针对弱势群体的基于技术的解决方案方面的专业知识。在五年的获奖期内，她将建立一个知识库，支持初级保健患者戒烟短信干预的开发、实施和评估。职业发展活动将包括定性研究方面的培训，使用移动技术作为提供健康建议的通信方法，以及临床试验设计。这项建议解决了文献中的重要空白，包括将吸烟者短信程序整合到医疗系统中的可行性，以及研究短信对戒烟药物依从性的影响。

 DESCRIPTION (provided by applicant): Tobacco cessation rates in the U.S. have changed little in the last decade. New interventions for smoking cessation are clearly needed. Text messaging has been identified as a promising modality for delivering smoking cessation support. There is little existing research which examines models that integrate text messaging interventions for smoking cessation within healthcare systems. Healthcare systems are important sites for delivering smoking cessation support given that 70% of smokers visit a physician each year. Integrating services within healthcare enables coordination of behavioral and pharmacologic interventions and leverages patient-provider relationships. Poor adherence to smoking cessation medications is thought to limit their effectiveness. Text-messaging has been used to promote adherence to medication in other condition but the use of text messaging to promote smoking cessation medication is not well studied. The proposed scientific program has two research aims: (1) To conduct qualitative focus groups among smokers (n=30) in community health centers to assess their preferences for text messaging from their healthcare provider and to explore their experience with nicotine replacement therapy and barriers to medication adherence in order to inform the design of a text messaging intervention, and (2) To test, in a pilot randomized controlled trial (N=106), the effect of delivering behavioral smoking cessation content with pharmacotherapy support by text message plus nicotine replacement therapy on self-reported quit attempts (intentional non-smoking for =24 hours), pharmacotherapy adherence, and biochemically confirmed smoking abstinence at the end of treatment. The principal investigator (PI) proposes a career development program that includes methodological training and mentorship by Harvard faculty to design and evaluate a text messaging intervention targeting smokers in community health centers. The long-term goal of this career development award is to develop Gina Kruse M.D., M.S., M.P.H. as an independent tobacco cessation researcher with expertise in technology-based solutions for vulnerable populations. During the five-year award period, she will develop a knowledge base that supports the development, implementation, and evaluation of a text messaging intervention for smoking cessation among primary care patients. Career development activities will include training in qualitative research, use of mobile technologies as a communication method for delivering health advice, and clinical trial design. This proposal addresses important gaps in the literature including the feasibility of integrating text messaging programs for smokers into healthcare systems and examining the effect of text messaging on smoking cessation medication adherence.