Project 4: Longitudinal Care; smoking reduction to aid cessation

背景超过75%的吸烟者表示他们想戒烟，但每年只有不到10%的人成功实现长期戒烟。烟草依赖的慢性性质已与糖尿病等其他医学疾病进行了比较，但目前对吸烟者的护理模式并没有纳入慢性疾病管理的原则。Objective.本项目的目的是进行一项随机对照试验，比较1）一年内提供的纵向护理戒烟治疗（LC）与2）离散的间歇性戒烟治疗（DC），以确定LC是否改善长期戒烟。方法.将招募440名有兴趣戒烟的吸烟者， 随机分配至LC或DC组。两组患者最初都将接受最先进的科学戒烟干预，包括行为和药理成分，通过面对面和电话护理相结合的方式提供。未能戒烟、减少但未戒烟或复发的LC参与者将在随后的12个月内接受强化治疗，鼓励重复戒烟尝试，如果他们还没有准备好戒烟，则减少吸烟。我们建议减少作为LC的中间目标，因为这可能会增加戒烟的可能性，提高自我效能，并保持吸烟者和临床医生的参与。还原处理 包括行为治疗和尼古丁替代DC参与者只会偶尔收到退出提示。主要终点将是入组后18个月测量的6个月禁欲。次要终点将包括点普遍戒烟，减少吸烟，自我效能和满意度。我们还将从成功的戒断者和减量者那里收集关于决策过程和干预经验的定性数据。意义该项目将讨论减少吸烟在有兴趣戒烟的吸烟者的治疗菜单中的潜在作用。该项目连同Hatsukami博士和Pentel博士的建议，审查减少毒素接触的机制、方法和“真实的世界”应用。

Background. More than 75% of smokers report that they would like to quit but each year less than 10% successfully achieve long-term abstinence each year. The chronic nature of tobacco dependence has been compared to other medical disorders such as diabetes, however current models of care for smokers do not incorporate principles of chronic disease management. Objective. The obj ective of this project is to conduct a randomized controlled trial to compare 1) a longitudinal care smoking cessation treatment delivered over a one-year period (LC) to 2) discrete episodic smoking cessation treatment (DC) to determine ifLC improves prolonged smoking abstinence. Methods. 440 smokers who are interested in quitting will be enrolled and randomly assigned to the LC or DC groups. Both groups will initially receive a state-of-the-science smoking cessation intervention including behavioral and pharmacological components, delivered by a combination of in-person and telephone care. LC participants who fail to quit, reduce but do not quit, or relapse will receive intensive treatment over the ensuing 12 months that encourages repeat quit attempts and smoking reduction if they are not ready to quit. We propose reduction as an intermediate goal in LC because this may increase the likelihood of cessation, increase self-efficacy and keep smokers and clinicians engaged. Reduction treatment will include behavioral treatment and nicotine replacement. DC participants will only receive occasional prompts to quit. The primary endpoint will be 6M of abstinence measured 18M after enrollment. Secondary endpoints will include point prevalent abstinence, smoking reduction, self-efficacy and satisfaction. We will also collect qualitative data from successful abstainers and reducers about decision making processes and intervention experiences. Significance. This project will address the potential role of smoking reduction in the treatment menu for smokers interested in quitting. This project, together with the Dr. Hatsukami and Dr. Pentel's proposals, examine mechanisms, methods and a "real world" application for reducing toxin exposure.