USING CONTINGENCY MANAGEMENT TO PROMOTE ADHERENCE TO SMOKING CESSATION TREATMENT AMONG HOSPITALIZED SMOKERS

项目总结/摘要 每年，近400万吸烟者在美国住院，创造了一个重要的机会，开始- 戒烟治疗。然而，在医院开始的戒烟治疗必须至少持续 出院后1个月有效。许多医院将吸烟者介绍给国家赞助的戒烟热线， 提供咨询跟进。最近的一项临床试验发现， 结合出院后戒烟热线支持，吸烟者戒烟的可能性增加了78%。然而，尽管如此， 大多数住院的吸烟者很少真正在戒烟热线上登记，那些登记的人也很少参加戒烟热线。 sessions.此外，大多数吸烟者从不填写出院后戒烟药物的处方。 需要新的方法来使住院吸烟者接受药物治疗和咨询，以增加他们的吸烟率。 戒烟的几率应急管理（CM）干预提供了财政奖励，视情况而定， 行为改变的客观证据，是增加戒烟电话参与度的有效方法， 来提高尼古丁口香糖的使用率我们在如何最好地 部署CM。尚未对CM进行增加住院后治疗参与度的测试。远程传递 CM通过移动的健康（mHealth）尚未进行戒烟治疗测试。更广泛地说，CM 同时激励联合干预的方法（如药物治疗+行为支持） 港）缺乏。拟议研究的目的是开发和测试的可行性和初步 mHealth提供的CM干预对提高住院吸烟者出院后参与度的有效性 心理咨询和药物治疗建议的研究有以下具体目标：1）制定一个 基于文本的干预（CounsCM+MedCM），以远程激励参与戒烟电话和伐伦克林 在出院后吸烟者中的利用率; 2）使用混合方法来了解优势，劣势， CounsCM+MedCM需要改进的地方; 3）评估可行性、可接受性和初步疗效 在一项初步随机对照试验中，将CounsCM+MedCM与非偶然“轭”对照（NCYC）进行比较。 博士Cruvinel是堪萨斯大学医学中心的博士后研究员，有经验和培训 采取干预措施，解决烟草、酒精和其他毒品使用问题。克鲁维内尔博士的职业目标是减少烟草- 通过新的循证护理提供系统， 重点是针对服务不足人群的移动健康干预措施。本专业的主要培训目标是： 学生将获得药物和行为临床试验、移动健康干预开发方面的技能， 发展CM干预的专业知识。建议的研究和培训计划的结果将有助于博士。 Cruvinel的发展作为一个独立的调查，并提供初步数据，为未来的大规模 功效研究

PROJECT SUMMARY/ABSTRACT Each year, nearly 4 million smokers are hospitalized in the US, creating an important opportunity to initiate to- bacco cessation treatment. However, smoking cessation treatment started in the hospital must continue at least 1 month post-discharge to be effective. Many hospitals refer smokers to state-sponsored tobacco quitlines to provide counseling follow up. A recent clinical trial found that varenicline use initiated during the hospital stay in combination with post-discharge quitline support increased smokers’ likelihood of quitting by 78%. Nevertheless, most inpatient smokers rarely actually register with the quitline, and those who do register participate in very few sessions. Furthermore, most smokers never fill their prescriptions for post-discharge cessation medications. Novel approaches are needed to engage hospitalized smokers in medication and counseling to increase their odds of quitting. Contingency management (CM) intervention provides financial incentives contingent upon ob- jective evidence of behavior change and is an effective approach to increase engagement in quitline calls and to increase rates of compliance with nicotine gum. Critical gaps remain in our knowledge about how best to deploy CM. CM has not been tested for increasing treatment engagement post-hospitalization. Remote delivery of CM via mobile health (mHealth) has not been tested for smoking cessation treatment. More broadly, CM approaches for concurrently incentivizing combined interventions (such as pharmacotherapy + behavioral sup- port) are lacking. The purpose of the proposed research is to develop and test the feasibility and preliminary efficacy of an mHealth-delivered CM intervention to increase hospitalized smokers’ post-discharge engagement in counseling and pharmacotherapy. The proposed research study has the following specific aims: 1) develop a text-based intervention (CounsCM+MedCM) to remotely incentivize engagement in quitline calls and varenicline utilization among post-discharged smokers; 2) to use mixed methods to understand strengths, weaknesses, and areas for improvement of CounsCM+MedCM; 3) to evaluate the feasibility, acceptability, and preliminary efficacy of CounsCM+MedCM compared to noncontingent “yoked” control (NCYC), in a pilot randomized controlled trial. Dr. Cruvinel is a postdoctoral associate at the University of Kansas Medical Center with experience and training in interventions to address tobacco, alcohol and other drug use. Dr. Cruvinel’s career goal is to reduce tobacco- related morbidity and mortality of hospitalized smokers through novel systems of evidence-based care delivery, with an emphasis on mHealth interventions for underserved populations. The primary training goals of this pro- posal are to gain skills in pharmaco-and behavioral clinical trials, mHealth intervention development, and to develop expertise in CM interventions. The results of the proposed research and training plans will facilitate Dr. Cruvinel's development as an independent investigator and provide preliminary data for a future large-scale efficacy study.