Integrated Smoking Cessation Treatment for Low Income Community Corrections

描述（由申请人提供）：刑事司法系统中的个人吸烟率比刑事司法系统外的个人高出约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和10次小组干预，并与等待名单对照组进行了比较，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罚机构以外的个人进行戒烟干预。拟议的网站，社区矫正，有一个种族多样性（60%的非洲裔美国人），低收入人口谁没有获得戒烟干预。本研究建议使用安非他酮作为平台，检查两种不同的行为干预戒烟与这种低收入，成年人口分层种族：4届会议，密集的咨询干预相比，医生咨询戒烟的初始会议（护理标准）。所有受试者将接受安非他酮治疗12周，戒烟率将根据基线、每周4次咨询会议、第8周和第12周（治疗结束）的可替宁和过期CO确定。将在研究入组后6、9和12个月进行随访。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，非洲裔美国人吸烟者的戒烟率将继续降低，尽管使用动机访谈干预预计会减弱这种影响。本研究通过检查一种新的治疗提供环境（社区矫正）来实现RFA的使命，该环境中低收入人群无法使用安非他酮进行戒烟治疗，并比较两种行为治疗强度。如果有效性得到证明，这项研究将提供一个模型，将戒烟治疗纳入现有的社区矫正罪犯计划，以帮助为低收入和服务不足的人群提供治疗。 公共卫生相关性：吸烟现在集中在低收入和其他弱势群体，如社区矫正。提供戒烟服务与社区矫正相结合，有可能为由于缺乏保险和其他贫困问题而无法获得社区戒烟干预措施的低收入人群提供这些服务。该项目有可能减少与吸烟有关的低收入社区矫正人口的发病率和死亡率。

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.