Testing Intervention Components for the Smoker who is Unwilling to Quit

吸烟是癌症的主要可预防原因，在美国每年直接医疗费用超过960亿美元。为了减少吸烟对健康和经济的巨大危害，我们需要一种全面的方法，让所有到医疗机构就诊的吸烟者接受有效和有效的治疗，帮助他们戒烟。不幸的是，大多数去看医疗保健的吸烟者不愿进行认真的戒烟尝试，而且几乎没有经验验证的治疗方法来激励他们戒烟，并为他们成功戒烟做好准备。总而言之，我们不知道对于不愿戒烟的吸烟者来说，哪些干预成分是最佳的？在任何时候，吸烟者都是大多数。项目2旨在为最初不愿戒烟的吸烟者确定高效的干预成分。吸烟者(N=512)定期到初级保健诊所就诊，不愿戒烟的吸烟者将被识别并使用增强的电子健康记录(EHR)进行招募。与多阶段优化策略(MOST)一致，我们将使用高效析因设计(2x2x2x2)来测试四种不同的干预成分：1)尼古丁替代类型(尼古丁口香糖与尼古丁迷你含片)，2)行为减少咨询(OFF/ON)，3)SRS动机咨询(OFF/ON)，以及4)行为激活咨询(OFF/ON)。这些成分有强大的理论和经验支持，但它们的相对、相加和交互作用尚不清楚。其中最有希望的成分将与本P01中其他项目中测试的其他成分相结合，形成一种慢性护理疗法，为吸烟干预的所有阶段提供有效治疗：从激励戒烟到戒烟康复。项目2通过计划的内部锁定设计与本P01中的其他项目相关联：当参与者在项目2中表示准备戒烟时，他们将在项目3中接受成本优化的戒烟治疗。因此，我们不仅将确定产生最大减烟和戒烟尝试的干预成分，还将确定哪些成分帮助吸烟者受益于吸烟治疗慢性护理模式中的下一个元素。

Cigarette smoking is the leading preventable cause of cancer and accounts for over $96 billion in annual direct medical costs in the US. To reduce the enormous health and economic harms of smoking, we need a comprehensive approach to engage all smokers visiting healthcare settings in treatment that efficiently and effectively helps them stop smoking. Unfortunately, most smokers making a healthcare visit are unwilling to make a serious quit attempt, and there are few empirically validated treatments to motivate them to quit and prepare them to quit successfully. In sum, we do not know which intervention components are optimal for smokers unwilling to quit¿a group that comprises the majority of smokers at any point in time. Project 2 aims to identify highly effective intervention components for smokers initially unwilling to quit. Smokers (N=512) making routine healthcare visits to primary care clinics who are unwilling to quit will be identified and recruited using an enhanced Electronic Health Record (EHR). Consistent with the Multiphase Optimization Strategy (MOST), we will use a highly efficient factorial design (2x2x2x2) to test four different intervention components: 1) Type of Nicotine Replacement (Nicotine Gum vs. Nicotine Mini-Lozenge), 2) Behavioral Reduction Counseling (off/on), 3) SRs Motivation Counseling (off/on), and 4) Behavioral Activation Counseling (off/on). These components have strong theoretical and empirical support, but their relative, additive, and interactive effects are unknown. The most promising of these components will be integrated with additional components tested in the other projects in this P01 to form a chronic care treatment that provides effective treatment for all phases of smoking intervention: from motivating quitting to recovering from relapse. Project 2 is linked to other projects in this P01 with a planned interiocking design: as participants express readiness to quit in Project 2, they will receive the Cost-Optimized Cessation treatment in Project 3. Thus, not only will we identify intervention components that produce the greatest smoking reduction and quit attempts, we will also identify which components help smokers benefit from the next element in a chronic care model for smoking treatment.