USING CONTINGENCY MANAGEMENT TO PROMOTE ADHERENCE TO SMOKING CESSATION TREATMENT AMONG HOSPITALIZED SMOKERS

项目摘要/摘要 在美国，每年有近400万吸烟者住院，这创造了一个重要的机会来发起- 戒烟治疗。然而，在医院开始的戒烟治疗必须至少继续进行 出院后1个月生效。许多医院建议吸烟者使用国家支持的戒烟热线 提供咨询和后续服务。最近的一项临床试验发现，在住院期间开始使用varenicline 与出院后戒烟支持相结合，吸烟者戒烟的可能性增加了78%。不过， 大多数住院吸烟者很少真正在戒烟热线上注册，而那些确实注册的人也很少参与。 会话。此外，大多数吸烟者从来没有给他们的出院后戒烟药物处方。 需要新的方法来吸引住院吸烟者进行药物治疗和咨询，以增加他们的 戒烟的几率。应急管理(CM)干预提供财务激励，视目标而定 是行为改变的客观证据，是增加对Qualline呼叫的参与度和 以提高尼古丁口香糖的依从率。在我们的知识中，关于如何最好地 部署CM。CM尚未接受住院后增加治疗参与度的测试。远程交付 通过移动健康(MHealth)进行的CM的戒烟治疗尚未进行测试。更广泛地说，CM 同时激励联合干预措施的方法(如药物治疗+行为支持) 端口)是缺乏的。拟议研究的目的是开发和测试可行性和初步 MHealth提供的CM干预提高住院吸烟者出院后参与度的效果 在咨询和药物治疗方面。拟议的研究性研究有以下具体目标：1)制定 基于文本的干预(CounsCM+MedCM)，远程激励Quiline呼叫和varenicline的参与 出院后吸烟者对吸烟者的利用；2)使用混合方法了解优点、缺点和 CounsCM+MedCM需要改进的领域；3)评估可行性、可接受性和初步疗效 在一项先导性随机对照试验中，将CounsCM+MedCM与非偶然性“负重”对照(NCyC)进行比较。 克鲁维内尔博士是堪萨斯大学医学中心的博士后助理，有丰富的经验和培训 在应对烟草、酒精和其他毒品使用的干预措施中。克鲁维内尔博士的职业目标是减少烟草-- 通过新的循证护理提供系统对住院吸烟者的相关发病率和死亡率， 重点是针对服务不足人群的移动健康干预措施。这位专业人员的主要培训目标是- Posal将获得药物和行为临床试验、mHealth干预开发方面的技能，并 发展CM干预方面的专业知识。拟议的研究和培训计划的结果将有助于Dr。 克鲁维内尔作为独立调查者的发展，并为未来的大规模 功效研究。

PROJECT SUMMARY/ABSTRACT Each year, nearly 4 million smokers are hospitalized in the US, creating an important opportunity to initiate to- bacco cessation treatment. However, smoking cessation treatment started in the hospital must continue at least 1 month post-discharge to be effective. Many hospitals refer smokers to state-sponsored tobacco quitlines to provide counseling follow up. A recent clinical trial found that varenicline use initiated during the hospital stay in combination with post-discharge quitline support increased smokers’ likelihood of quitting by 78%. Nevertheless, most inpatient smokers rarely actually register with the quitline, and those who do register participate in very few sessions. Furthermore, most smokers never fill their prescriptions for post-discharge cessation medications. Novel approaches are needed to engage hospitalized smokers in medication and counseling to increase their odds of quitting. Contingency management (CM) intervention provides financial incentives contingent upon ob- jective evidence of behavior change and is an effective approach to increase engagement in quitline calls and to increase rates of compliance with nicotine gum. Critical gaps remain in our knowledge about how best to deploy CM. CM has not been tested for increasing treatment engagement post-hospitalization. Remote delivery of CM via mobile health (mHealth) has not been tested for smoking cessation treatment. More broadly, CM approaches for concurrently incentivizing combined interventions (such as pharmacotherapy + behavioral sup- port) are lacking. The purpose of the proposed research is to develop and test the feasibility and preliminary efficacy of an mHealth-delivered CM intervention to increase hospitalized smokers’ post-discharge engagement in counseling and pharmacotherapy. The proposed research study has the following specific aims: 1) develop a text-based intervention (CounsCM+MedCM) to remotely incentivize engagement in quitline calls and varenicline utilization among post-discharged smokers; 2) to use mixed methods to understand strengths, weaknesses, and areas for improvement of CounsCM+MedCM; 3) to evaluate the feasibility, acceptability, and preliminary efficacy of CounsCM+MedCM compared to noncontingent “yoked” control (NCYC), in a pilot randomized controlled trial. Dr. Cruvinel is a postdoctoral associate at the University of Kansas Medical Center with experience and training in interventions to address tobacco, alcohol and other drug use. Dr. Cruvinel’s career goal is to reduce tobacco- related morbidity and mortality of hospitalized smokers through novel systems of evidence-based care delivery, with an emphasis on mHealth interventions for underserved populations. The primary training goals of this pro- posal are to gain skills in pharmaco-and behavioral clinical trials, mHealth intervention development, and to develop expertise in CM interventions. The results of the proposed research and training plans will facilitate Dr. Cruvinel's development as an independent investigator and provide preliminary data for a future large-scale efficacy study.