Integrated Smoking Cessation Treatment for Low Income Community Corrections

描述（由申请人提供）：刑事司法系统中个人的吸烟率大约是刑事司法系统外个人的3- 4倍，很少有戒烟干预措施针对这一人群。一项针对女性囚犯的大型随机对照试验测试了尼古丁替代疗法和10次小组干预，并与等候名单对照组进行了比较，结果发现戒烟率与其他社区试验相当。然而，尽管需要在低收入和其他服务不足的人群中测试吸烟干预措施，但尚未对社区矫正监督下的刑事机构以外的个人进行戒烟干预。拟议的社区矫正场所有种族多样化（60%是非裔美国人）的低收入人群，他们无法获得戒烟干预措施。本研究建议以安非他酮为平台，对低收入、按种族分层的成年人群进行两种不同的戒烟行为干预：4期强化咨询干预与初始期医生咨询戒烟（标准护理）相比。所有参与者将接受12周的安非他酮治疗，戒断率将基于可替宁和过期的CO作为基线，每周一次的咨询会议，第8周和第12周（治疗结束）。随访将在研究入组后的6、9和12个月进行。GEE分析将用于检查多个时间点的干预效果，据信，与白人吸烟者相比，非裔美国吸烟者的戒烟率将继续较低，尽管这种效果预计将通过动机性访谈干预来减弱。本研究通过研究一种新的治疗交付环境（社区矫正）来完成RFA的使命，该环境适用于无法使用安非他酮进行戒烟治疗的低收入人群，并比较了两种强度的行为治疗。如果有效性被证明，本研究将提供一个模型，将戒烟治疗整合到现有的社区矫正罪犯项目中，以帮助为低收入和服务不足的人群提供治疗。

DESCRIPTION (provided by applicant): Smoking prevalence among individuals in the criminal justice system is approximately 3- 4 times higher than among individuals outside the criminal justice system and few smoking cessation interventions have targeted this population. One large RCT of female prisoners tested nicotine replacement and 10-session group intervention compared to a wait-list control group and found comparable cessation rates with other community trials. However, smoking cessation interventions have not been conducted with individuals outside penal institutions under community corrections supervision, despite the need to test smoking interventions with low income and other underserved populations. The proposed site, community corrections, has a racially diverse (60% African-American), low income population who do not have access to smoking cessation interventions. This study proposes to examine using bupropion as the platform to examine two different behavioral interventions for smoking cessation with this low income, adult population stratifying for race: a 4 session, intensive counseling intervention compared to an initial session of physician counseling to quit (standard of care). All participants will be treated for 12 weeks with bupropion and abstinence rates will be determine based on cotinine and expired CO for baseline, 4 weekly counseling sessions, weeks 8 and 12 (end-of- treatment). Follow-ups will be at 6, 9 and 12 months after study enrollment. GEE analyses will be used to examine the effect of the intervention over multiple time points and it is believed that African-American smokers will continue to have lower smoking cessation rates compared to Caucasian smokers, although this effect is expected to be attenuated using the motivational interviewing intervention. This study fulfills the RFA mission by examining a novel treatment delivery setting (community corrections) with a low income population who do not have access to smoking cessation treatment using buproprion and comparing two intensities of behavioral therapy. If efficacy is demonstrated, this study would provide a model for integrating smoking cessation treatment in existing programs for community corrections offenders to help provide treatment to a low income and underserved population. PUBLIC HEALTH RELEVANCE: Smoking is now concentrated in low income and other disadvantaged populations such as community corrections. Providing smoking cessation services integrated with community corrections has the potential to provide these services to a low income population who are not able to access community smoking cessation interventions due to lack of insurance and other poverty issues. This project has the potential to reduce the morbidity and mortality associated with smoking with this low income, community corrections population.