RE-AIM Evaluation of Tailored Smoking Harm Reduction

描述(由申请人提供)：这项修订后的提案将解决现有计划中帮助住院吸烟者的几个限制，包括覆盖范围和可出口性。我们将使用RE-AIM评估模型来调查一种创新的干预措施，该干预措施适用于在科罗拉多州凯撒永久医院接受门诊手术或侵入性内窥镜检查(乙状结肠镜/结肠镜检查)但拒绝参与戒烟活动的吸烟者。基于前期工作和以前对吸烟者进行减害干预的经验，我们将提供一个减害计划，目标是帮助吸烟者实现每天减少三分之二的香烟摄入量。基于理论的干预将包括目标设定和频繁反馈、基于障碍的问题解决以及其他为吸烟者及其社会环境量身定做的社会认知程序。它将在手术前(或内窥镜手术)和之后通过电话咨询和量身定制的邮件相结合的方式提供，类似于作为该互动RO1应用程序的一部分提出的戒烟计划(项目1)。我们实验室和其他研究人员之前的工作表明，吸烟数量减少50%-75%是可以实现的，并且可以在不导致补偿吸烟的方式下实现，从而实现并保持生化暴露的减少。经过一年的开发工作，我们将对340名吸烟者进行随机试验，将减少危害计划与将收到普通邮件的控制条件进行比较。根据RE-AIM模型，该项目的主要成果将是1)REACH(参与该计划的吸烟者的百分比和代表性)；2)有效性：在3个月的随访中减少香烟、可替宁和一氧化碳水平；3)采纳率：参与该计划的医生的百分比；4)实施：接受和使用几种干预成分中每一种的参与者的百分比；以及5)维持：戒烟率、香烟和唾液可替宁的减少，以及一年随访时的一氧化碳水平。这是使用互动研究项目资助机制提交的两个项目之一。将对与传播和经济成果有关的各种RE-AIM层面进行跨项目分析。总而言之，这两个项目将为服务不足的人群(医院环境中的患者)提供一个综合计划的重要测试，该计划承认戒烟和减少伤害是互补的战略。

DESCRIPTION (provided by applicant): This revised proposal will address several limitations of existing programs to help hospitalized smokers, including reach and exportability. We will use the RE-AIM evaluation model to investigate an innovative intervention for reaching and involving smokers about to have out-patient surgery or an invasive endoscopic medical procedure (sigmoidoscopy/colonoscopy) in Kaiser Permanente-Colorado, but who decline to participate in cessation-based smoking activities. Based upon preliminary work and previous experience with harm reduction interventions with smokers, we will offer a harm reduction program with the goal of helping smokers achieve a 2/3 reduction in daily cigarette intake. The theory-based intervention will include goal setting and frequent feedback, barriers-based problem-solving, and other social-cognitive procedures tailored to the smoker and his or her social environment. It will be delivered both before surgery (or endoscopic procedures) and after, by a combination of phone counseling and tailored mailings, similar to that of the smoking cessation program (Project 1) proposed as part of this Interactive RO1 application. Previous work in our lab and by other investigators indicates that 50-75 percent reduction in number of cigarettes smoked is achievable and can be done in a way that does not result in compensatory smoking, so that reductions in biochemical exposures are achieved and maintained.Following a year of developmental work, we will conduct a randomized trial with 340 smokers to compare the harm reduction program to a control condition that will receive generic mailings. Following the RE-AIM model, key outcomes of the project will be 1) Reach (percent and representativeness of smokers who participate in this program); 2) Effectiveness: reductions in number of cigarettes, cotinine, and CO levels at 3 months follow-up; 3) Adoption: the percent of physicians who participate in the program; 4) Implementation: the percent of participants who receive and use each of several intervention components; and 5) Maintenance: the cessation rate, reduction in number of cigarettes and saliva cotinine, and CO levels at one-year follow-up.This is one of two projects being submitted using the Interactive Research Project Grant funding mechanism. Crossproject analyses will be conducted on various RE-AIM dimensions related to dissemination and economic outcomes. Taken together, both projects will provide an important test of an integrated program for an underserved population (patients in the hospital setting) that recognizes cessation and harm reduction as complementary strategies.