Preventing Relapse Following Involuntary Smoking Abstinence

描述（由申请人提供）：吸烟是这个国家发病率和死亡率的头号可预防原因8,9。对于那些试图戒烟的人来说，预防复发是重中之重，因为大多数试图戒烟的人在很短的时间内就会复发。在接受正式戒烟计划的吸烟者中，至少有70%的人复吸；在自我戒烟者中，复发率约为90% 11。然而，事实是，绝大多数试图戒烟的吸烟者没有得到或只有很少的帮助。基于人群的方法，如戒烟线和互联网干预措施正变得越来越普遍，因为该领域直接转向强调传播。虽然绝大多数吸烟者都试图自己戒烟，但令人惊讶的是，关于减少自我戒烟者复吸的研究很少。布兰登和他的同事们已经证明，一系列的8种自助手册在那些自己戒烟的吸烟者中始终如一地产生了更高的点流行戒断率。鉴于这种方法对公共卫生的巨大影响，显然需要更多关于促进长期自我戒烟的研究。迄今为止，几乎所有关于促进自我戒烟的研究都是在参与者在参与干预之前自愿戒烟的样本中进行的6,7。然而，对于预防非自愿戒断后复发的方法（例如，军事训练、住院期间、在拘留所、监狱和精神病院）却一无所知。先前的研究1,2已经确定，在没有其他干预的情况下，军队中长期的非自愿戒烟与显著的长期戒烟率（一年随访15- 20%）有关。因为，据我们所知，没有研究成功地干预了长期非自愿戒烟后的复发率，我们的具体目标如下：(1)招募大约5200名美国空军（USAF）新兵在基本军事训练（BMT）结束时，在BMT期间8周非自愿戒烟之前是常规吸烟者；(2)随机分配参与者：(a)标准强迫戒烟，(b)强迫戒烟+印刷材料（在先前的研究中证明对那些自愿戒烟的人有效），(c)强迫戒烟+ 3次主动预防复发的电话，或(d)强迫戒烟+印刷材料+ 3次主动预防复发的电话，在2 × 2的因子设计中（印刷材料是与否交叉与主动电话治疗，是与否）。(3)确定戒烟维持干预的长期（12个月）疗效。我们的主要结果是在12个月的随访中戒烟维持。次要结果是6个月随访时的戒烟维持情况。

DESCRIPTION (provided by applicant): Cigarette smoking is the number one preventable cause of morbidity and mortality in this nation 8, 9. Preventing relapse is a high priority for those attempting to quit smoking as most people who attempt cessation relapse within a very short period of time 10. Of smokers who receive a formal cessation program, at least 70 percent relapse 10; among self-quitters, the relapse rate is approximately 90 percent 11. It is the case, however, that the vast majority of smokers who try to stop smoking do so with no or with minimal assistance 12. Population-based approaches such as tobacco quit lines and internet interventions are becoming increasingly more prevalent 13-15 16 as the field moves directly towards an emphasis on dissemination. While the vast majority of smokers try to quit on their own, surprisingly little research has been conducted on reducing relapse among self-quitters. Brandon and colleagues 6, 17 7 have demonstrated that a series of 8 printed self-help booklets consistently produced higher point-prevalence abstinence rates in smokers that had quit on their own. Given the enormous public health implications of this approach, more research on promoting long-term self-quitting is clearly needed. Virtually all research to date on promoting self-quitting has been conducted in samples where participants have voluntarily stopped smoking prior to participating in the interventions 6, 7. However, nothing is known about methods of preventing relapse following involuntary abstinence (e.g., military training, during hospital stays, in jails, prisons, & psychiatric facilities). Previous research 1, 2 has determined that protracted involuntary cessation in the military with no other intervention is associated with significant long-term cessation rates (15- 20 percent at a one-year follow-up). Since, to our knowledge, no study has successfully intervened to reduce relapse rates following a protracted involuntary abstinence, our specific aims are as follows: (1) To recruit approximately 5200 United States Air Force (USAF) recruits at the end of Basic Military Training (BMT) who were regular smokers prior to an 8-week involuntary cessation during BMT; (2) To randomize participants either to (a) standard forced cessation, (b) forced cessation + printed materials (proven to be efficacious in previous studies among those who voluntarily quit on their own), (c) forced cessation + 3 proactive relapse prevention telephone calls, or (d) forced cessation + printed materials + 3 proactive relapse prevention telephone calls, in a 2 x 2 factorial design (printed materials yes vs. no crossed with proactive telephone treatment, yes vs. no). (3) To determine the long-term (12 month) efficacy of the cessation maintenance intervention. Our primary outcome is smoking cessation maintenance at the 12 month follow-up. The secondary outcome is smoking cessation maintenance at the 6 month follow-up. PUBLIC HEALTH RELEVANCE: Despite large campaigns, over 22 percent of adult Americans smoke. The vast majority of people try to quit smoking on their own but most fail at these attempts. The current study will test ways of helping people who have quit involuntarily to maintain their abstinence. Since smoking is the #1 cause of premature mortality and morbidity in this country, the public health significance of this project is high.