Addressing Tobacco Use in a Homeless Population

描述（由申请人提供）：在一年中，估计有230万至350万美国人无家可归。与美国普通人群相比，无家可归者吸烟的比例高出三倍以上，导致了过高的发病率和死亡率。尽管存在这种差异，但对无家可归吸烟者的烟草使用特征和戒烟意愿预测因素的研究相对较少。很少有研究对这一人群的戒烟干预措施进行了严格的测试，迄今为止进行的研究也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。为了解决这些证据上的差距，首席研究员（PI）提出了一项职业发展计划，该计划将哈佛大学教师严格的方法培训与创新的研究议程相结合，该议程建立在马萨诸塞州总医院（MGH）和波士顿无家可归者保健计划（BHCHP）之间独特的学术社区合作伙伴关系之上。这个职业发展计划有三个科学目标：1)评估无家可归成人队列中吸烟导致的死亡率、发病率和医疗保健利用情况；2)描述无家可归吸烟者的烟草使用特征，评估影响吸烟决策平衡、吸烟奖励价值和戒烟意愿的因素；3)开展随机对照试验，评估基于现金的应急管理（CM）戒烟干预无家可归吸烟者的可行性和有效性。社会管理战略利用财政激励来加强减少和戒烟；这些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试验。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和减少特殊人群吸毒成瘾的差异。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专业知识，PI概述了一项计划，通过正式的研究生水平课程以及由国际公认的与当前提案直接相关的研究领域的领导者组成的非常合格的资深科学家团队的指导，获得戒烟研究、行为科学、干预设计和无家可归者研究方面的专业知识。成功完成这一职业发展计划将使PI成为无家可归者吸烟方面的专家，并提高他作为一名独立调查员开展以病人为导向的研究的能力，重点关注无家可归者的这一行为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.