Addressing Tobacco Use in a Homeless Population

描述（由申请人提供）：估计有230万至350万美国人在给定的一年无家可归。与美国普通人群相比，无家可归者中吸烟的比例高出三倍以上，导致发病率和死亡率过高。尽管存在这种差异，但对无家可归的吸烟者的烟草使用特征和戒烟准备的预测因素的研究相对较少。很少有研究在这一人群中严格测试戒烟干预措施，迄今为止进行的研究显示出一般适度的结果。解决这一弱势群体的烟草使用问题需要更好地了解这一问题，并采取新的治疗方法。为了解决这些差距的证据，主要研究者（PI）提出了一个职业发展计划，融合了严格的方法论培训，由哈佛教师与创新的研究议程，建立在一个独特的学术社区之间的伙伴关系马萨诸塞州总医院（MGH）和波士顿医疗保健无家可归者计划（BHCHP）。该职业发展计划有三个科学目标：1）估计无家可归成年人队列中吸烟导致的死亡率、发病率和卫生保健利用率，2）描述无家可归吸烟者的烟草使用特征，并评估影响吸烟决策平衡、吸烟奖励价值和戒烟准备的因素，及3）进行一项随机对照试验，以评估以现金为基础的应急管理（CM）戒烟干预对无家可归吸烟者的可行性和有效性。CM战略利用财政激励措施来加强减少吸烟和戒烟;这种方法在促进其他弱势群体戒烟方面显示出有希望的结果，但从未在无家可归的吸烟者中进行过测试。拟议的研究项目补充了国家药物滥用研究所（NIDA）的战略重点，即开发新的行为治疗方法，减少特殊人群药物成瘾的差异。此外，该项目还涉及NIDA感兴趣的其他几个领域，包括流行病学，卫生服务和医疗后果。为了补充他在无家可归者医疗保健方面的内容专业知识，PI概述了一项计划，通过正式的研究生课程以及由一个非常合格的资深科学家团队指导，获得戒烟研究，行为科学，干预设计和无家可归人群研究方面的专业知识，这些科学家是国际公认的领导者，他们在与当前提案直接相关的研究领域。该职业发展计划的成功完成将使PI成为无家可归者烟草使用方面的专家，并提高他作为独立调查员开展以患者为导向的研究的能力，重点关注无家可归者的这一和其他高风险健康行为。

DESCRIPTION (provided by applicant): An estimated 2.3-3.5 million Americans are homeless during a given year. Cigarette smoking is over three times more common among homeless individuals in comparison to the US general population, contributing to excess morbidity and mortality. Despite this disparity, there is relatively little research on the tobacco use characteristics and predictors of readiness to quit in homeless smokers. Few studies have rigorously tested smoking cessation interventions in this population, and those conducted to date have demonstrated generally modest results. Addressing tobacco use in this vulnerable population will require a better understanding of the problem and a novel approach to its treatment. To address these gaps in evidence, the principal investigator (PI) proposes a career development program that blends rigorous methodologic training by Harvard faculty with an innovative research agenda that builds upon a unique academic-community partnership between Massachusetts General Hospital (MGH) and Boston Health Care for the Homeless Program (BHCHP). This career development plan has three scientific objectives: 1) To estimate smoking-attributable mortality, morbidity, and health care utilization in a cohort of homeless adults, 2) To describe the tobacco use characteristics of homeless smokers and assess the factors influencing decisional balance for smoking, reward value of smoking, and readiness to quit, and 3) To conduct a pilot randomized controlled trial to assess the feasibility and efficacy f a cash-based contingency management (CM) tobacco cessation intervention for homeless smokers. CM strategies utilize financial incentives to reinforce smoking reduction and cessation; such methods have shown promising results in promoting smoking cessation in other vulnerable populations but have never been tested in homeless smokers. The proposed research project complements the National Institute on Drug Abuse (NIDA) strategic focus on developing novel behavioral treatments and reducing disparities in drug addiction in special populations. Additionally, this project taps into several other areas of interest at NIDA, including epidemiology, health services, and medical consequences. To complement his content expertise in homeless health care, the PI has outlined a plan for acquiring expertise in tobacco cessation research, behavioral science, intervention design, and research in homeless populations through formal graduate-level coursework as well as mentorship by an exceptionally-qualified team of accomplished senior scientists who are internationally-recognized leaders in areas of research directly relevant to the current proposal. The successful completion of this career development plan will establish the PI as an expert in tobacco use among homeless individuals and enhance his ability to conduct patient-oriented research as an independent investigator focusing on this and other high-risk health behaviors in homeless persons.