Efficiency of sustained cessation for population

描述：(申请人描述)关于如何最好地将有效的戒烟治疗转化为有效的公共卫生干预措施的研究不足。公共卫生干预措施通过主动招募惠及许多人，但有效的为数不多，而基于临床的干预措施惠及少数人(反应性干预和自选干预)，但有效。终生并存的风险也会削弱临床和公共卫生干预的效率。相当大比例的成年吸烟者由于共病(即尼古丁依赖、精神疾病、戒烟的多重心理社会障碍)而面临吸烟治疗失败的高风险。家族性、产前尼古丁暴露和儿童早期风险因素对成人治疗反应的影响尚未在我们所知的任何研究中得到检验。我们将从跨代纵向国家合作围产期项目(NCPP)中主动招募年龄在34岁至40岁之间的受试者-G2一代。G2的S从出生起就被跟踪，并有关于产前、产后和儿童早期风险因素的详细信息。在NCPP(32代)的基线结构化访谈期间，我们还将收集关于成人吸烟模式和吸烟治疗失败的共病风险因素的昂贵的终生和并发数据。因此，我们建议从NCCP纵向队列中主动招募样本，调查家族性、儿童早期和成人终生风险因素与治疗反应之间的关系。这项研究还试图通过将公共卫生方法(主动接触)的优势与更密集的临床策略(多模式、持续接触)的优势结合起来，弥合公共卫生和临床干预之间的差距。主要目的是：1)在780名受试者的随机试验中，比较两种戒烟干预措施--短暂电话咨询(BTC)和持续多模式咨询(SMC)的有效性，并在基线后对780名受试者进行24个月的跟踪调查；2)检查儿童早期和成年后一生高风险和低风险特征与治疗反应的关系。我们还将检查成本效益，并进行程序和流程到结果分析，以检查提供和接受的干预剂量。在临床和公共卫生干预措施之间采用跨学科方法，使用从跨代NCPP研究中提取的公共社区样本，可以促进对尼古丁依赖、终身风险因素以及这些变量与治疗反应相互作用的基本生物行为机制的理解。

DESCRIPTION: (Applicant's Description) There has been insufficient research on how best to translate effective smoking cessation treatments into efficient public health interventions. Public health interventions reach many through proactive recruitment but are efficacious with few, while clinic- based interventions reach few, (reactive and self-selected), but are effective. Lifetime comorbid risk can also attenuate the efficiency of both clinical and public health interventions. A significant proportion of adult smokers are at high risk for smoking treatment failure by virtue of comorbidity (i.e., nicotine dependent, psychiatric comorbidity, multiple psychosocial barriers to quitting). The influence of familial, prenatal nicotine exposure, and early childhood risk factors on adult response to treatment has not been examined in any study we are aware of. We will recruit subjects proactively from the transgenerational longitudinal National Collaborative Perinatal Project (NCPP) who are now aged 34 to 40 - the G2 generation. The G2's have been followed since birth and detailed information is available on prospective prenatal, postnatal, and early childhood risk factors. During baseline structured interviews of the (32 generation of the NCPP, we will also gather expensive lifetime and concurrent data on adult smoking patterns and co- morbid risk factors for smoking treatment failure. Thus we propose to investigate the relationship between familial, early childhood and adult lifetime risk factors and response to treatment in a proactively recruited sample from the NCCP longitudinal cohort. This study also seeks to bridge the gap between public health and clinical interventions by coupling the advantages of a public health approach (proactive reach) with the advantages of a more intensive clinical strategy (multi-modal, sustained contact). The primary aims are: 1) to compare the efficacy of two smoking cessation interventions, Brief Telephone Counseling (BTC) and Sustained Multi-Modal Counseling (SMC) in a randomized trial of 780 subjects followed for 24 months after baseline and, 2) to examine the relationship between early childhood and adult lifetime high and low risk profiles and treatment response. We will also examine cost-effectiveness and conduct program and process to outcomes analysis to examine the dosage of intervention delivered and received. A transdisciplinary approach at the interface between clinical and public health interventions, using a common community sample drawn from the trans- generational NCPP study, can advance the understanding of basic bio- behavioral mechanisms in nicotine dependence, lifetime risk factors and the interactions of these variables with treatment response.