Strategies To Promote Cessation in Smokers Who Are Not Ready To Quit

 描述（由申请人提供）：几乎所有的戒烟干预措施都是对表示愿意戒烟的吸烟者进行的。研究得少得多的是帮助目前还没有准备好戒烟的吸烟者的方法（例如，不是在未来30天内）。尽管大多数吸烟者在任何给定的时间点都没有准备好戒烟，但对未准备好戒烟的吸烟者的研究仍然很少。虽然近69%的吸烟者希望在未来的某个时候戒烟，但只有不到10%的吸烟者准备在未来30天内进行认真的戒烟尝试。有两种不同的方法可以提高未准备戒烟的吸烟者（SNRTQ）的戒烟率。第一种方法动机面试（MI）使用“5 R”作为基础（相关性，风险，奖励，路障，重复）。然而，只有一项研究，这是一个十年的历史，已经评估了与SNRTQ的MI的影响-与MI产生更高的戒烟尝试和戒烟比a）减少咨询使用尼古丁替代疗法加简短的建议单独和B）没有治疗。第二种方法结合行为/药理率降低作为一种方法，以减少烟草使用，以及提高戒烟的自我效能。结合行为/药理率降低已被证明是SNRTQ戒烟几率的两倍以上。据我们所知，没有研究评估MI和心率降低单独与联合使用对激励SNRTQ增加戒烟尝试和戒烟的独立影响。因此，我们提出以下具体目标：（1）测试SNRTQ的戒烟线;（2）将2100个SNRTQ随机分为：（a）简要建议+典型戒烟资源（B）使用临床实践指南推荐的5 R（MI/5 R）格式的动机访谈;（c）行为和药理学联合速率降低，和（d）MI/5 R+行为和药理学联合速率降低。该设计使我们能够评估MI和心率降低对戒烟尝试和戒烟的独立和累加效应;（3）评估干预的有效性。主要终点将是干预后6个月随访（随机化后12个月）时的点患病率。干预后6个月随访时的长期戒烟和干预后2个月、4个月、6个月和6个月随访时的戒烟尝试是次要终点;（4）确定每种干预措施的成本效益（每名戒烟者的成本）。目前的提案解决了SNRTQ服务不足的人口问题，具有高度的重要性和创新性，并对公共卫生产生了巨大的影响。

 DESCRIPTION (provided by applicant): Virtually all smoking cessation interventions have been conducted on smokers who indicate a willingness to quit smoking. Much less well-studied are approaches for assisting smokers who are not ready to quit smoking at the current time (ex., not in the next 30 days). The paucity of research on smokers not ready to quit smoking is present despite the fact that the majority of smokers are not ready to quit smoking at any given point in time. While almost 69% of smokers want to quit at some time in the future, fewer than 10% of smokers are ready to make a serious smoking cessation attempt in the next 30 days. There have been two different approaches towards increasing cessation rates in smokers not ready to quit (SNRTQ). The first approach Motivational Interviewing (MI) using "5Rs"as a foundation (Relevance, Risks, Rewards, Roadblocks, Repetition). However, only one study, which is a decade old, has evaluated the impact of MI with SNRTQ - with MI producing both higher quit attempts and smoking cessation than a) reduction counseling using nicotine replacement therapy plus brief advice alone and b) no treatment. The second approach combined behavioral/pharmacological rate reduction as an approach to produce reductions in tobacco use as well as to enhance self-efficacy for smoking cessation Combined behavioral/pharmacologic rate reduction has been shown to more than double the odds of cessation in SNRTQ. To our knowledge, no study has evaluated the independent effects of MI and Rate Reduction, individually versus in combination, for motivating SNRTQ to increase both quit attempts and tobacco abstinence. Thus, we propose the following Specific Aims: (1) To test a tobacco Quit Line for SNRTQ; (2) To randomize 2100 SNRTQs to: (a) Brief Advice + typical smoking cessation resources (control group); (b) Motivational Interviewing using the 5Rs (MI/5Rs) format recommended by the Clinical Practice Guidelines; (c) Combined behavioral and pharmacologic Rate Reduction, and (d) both MI/5Rs + combined behavioral and pharmacologic Rate Reduction. This design allows us to evaluate the independent and additive effects of MI and Rate Reduction on quit attempts and smoking cessation; (3) to evaluate the efficacy of the intervention. The primary endpoint will be point prevalence at the 6-month post-intervention follow-up (12 months after randomization). Prolonged abstinence at the 6-month post intervention follow-up and quit attempts at the 2-, 4- and 6-month and the 6-month post intervention follow-up are secondary endpoints, and; (4) To determine the cost effectiveness (cost per quit smoker) of each of the interventions. The current proposal addresses the underserved population of SNRTQ is highly significant, innovative, and has a tremendous public health impact.