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还不够。通过主动招募，公共卫生干预措施覆盖了许多人，但有效的人很少，而基于诊所的干预措施覆盖的人很少（被动的和自我选择的），但有效。终生共病风险也会降低临床和公共卫生干预措施的效率。相当大比例的成年吸烟者由于共病（即尼古丁依赖、精神共病、戒烟的多重心理障碍）而面临吸烟治疗失败的高风险。据我们所知，在任何研究中都没有检查过家族性、产前尼古丁暴露和幼儿期危险因素对成人治疗反应的影响。我们将从跨代纵向国家协作围产期计划（NCPP）中主动招募年龄在34 - 40岁的G2一代。自出生以来一直对G2进行跟踪，并提供有关产前，产后和幼儿期风险因素的详细信息。在第32代NCPP的基线结构化访谈中，我们还将收集有关成人吸烟模式和吸烟治疗失败的共病危险因素的昂贵终生和并发数据。因此，我们建议从NCCP纵向队列中主动招募样本，调查家族、幼儿期和成年期危险因素与治疗反应之间的关系。本研究还试图通过将公共卫生方法的优势（主动接触）与更密集的临床策略的优势（多模式、持续接触）结合起来，弥合公共卫生与临床干预之间的差距。主要目的是：1)比较两种戒烟干预措施的效果，简短电话咨询（BTC）和持续多模式咨询（SMC）在780名受试者的随机试验中，基线后随访24个月；2)检查儿童早期和成人一生高风险和低风险概况与治疗反应之间的关系。我们还将检查成本效益，并进行项目和过程到结果分析，以检查提供和接受的干预剂量。临床和公共卫生干预之间的跨学科方法，使用来自跨代NCPP研究的共同社区样本，可以促进对尼古丁依赖的基本生物行为机制，终生风险因素以及这些变量与治疗反应的相互作用的理解。

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.