Cancer Risk Reduction Through Combined Treatment for Tobacco and Alcohol Use

摘要 烟草是导致可预防死亡和残疾的主要原因，酒精是第三大原因。 几乎三分之一的癌症直接归因于吸烟，而酒精会增加患癌症的风险。 口腔癌、咽癌、喉癌、食道癌、肝癌、结肠癌、直肠癌和乳癌。此外，伴随 烟草和酒精的使用协同地增加了某些癌症的风险（例如，头部和颈部）。不仅 烟草和酒精的使用本身就是重大的公共卫生问题，它们是密切相关的行为。 吸烟者比不吸烟者更容易喝酒，问题饮酒的流行率也更高。 吸烟者比不吸烟者高。 不幸的是，吸烟和饮酒是波多黎各（PR）的主要公共卫生问题。虽然 居住在波多黎各的波多黎各人的吸烟率（12.5%）低于美国大陆（20.6%）， PR中的五个主要死亡原因与吸烟有关（即，心脏病癌症中风 高血压和慢性肺病）。同样，尽管波多黎各人不太可能喝酒， 无论是美国的普通民众还是美国的西班牙裔，他们更有可能是狂饮者， 他们确实喝酒（http：//www.cdc.gov/brfss/）。此外，酒精对健康的负面影响， 烟草并不严格限于重度或滥用。例如，每种与酒精有关的 男性每天饮酒超过两杯，癌症就会大幅增加， 女性每天喝多少事实上，医学研究所（IOM）的一份具有里程碑意义的报告确定了“处于危险之中”。 饮酒（慢性中度至重度使用、酗酒或酒后驾车）作为严重公众 因为它还与许多其他负面健康和社会后果有关 癌症因此，国际移民组织建议将筛查、预防和治疗风险综合起来， 公共卫生机构饮酒。因此，减少波多黎各人癌症风险的一项重要战略是， 吸烟者正在减少这两种物质的使用。 这项拟议的研究是一项随机临床试验，将评估一种独特的、理论上和 基于医学的“动机和问题解决”（MAPS）方法来治疗烟草和危险酒精 在基于人群的公共卫生环境中使用。MAPS是一种治疗方法， 动机访谈和认知行为/解决问题的治疗方法。参与者 波多黎各吸烟者也是“危险”饮酒者，他们因吸烟而拨打波多黎各戒烟热线（PRO） 戒烟咨询根据国家酒精滥用和酒精中毒研究所的定义， 指的是一系列增加身体和心理问题风险的酒精使用行为。 我们之前在吸烟者中进行的研究表明，36%的吸烟者处于危险之中。 受试者（N=200）将被随机分配至以吸烟为重点的MAPS治疗组 戒烟，或MAPS+条件，重点是戒烟和减少危险酒精使用。 治疗以电话为基础，旨在方便地传播到卫生保健系统和其他 以人口为基础的烟草和酒精控制环境。主要结果变量是饮酒风险。我们 假设相对于MAPS，MAPS+将减少危险酒精使用行为。虽然我们也会 研究戒烟的结果，我们相信MAPS和 关于戒烟结果的MAPS+。虽然MI和认知行为/问题解决 这些方法在治疗酒精使用和戒烟方面有着相对悠久的历史， 据我们所知，这项研究将是第一个应用动机增强方法， 治疗吸烟和酗酒。需要注意的是，MAPS+的目标不一定是促进 戒酒，但要改变危险的饮酒行为。 该项目的具体目标是： 1.评估MAPS和MAPS+对波多黎各人有风险的酒精使用（和戒烟）的影响 吸烟者也是危险的饮酒者。 2.评估MAPS和MAPS+对治疗机制的影响以及这些机制在以下方面的作用： 介导对危险饮酒（和戒烟）的治疗效果。 3.评估MAPS和MAPS+在减少风险饮酒（和吸烟）方面的成本效益 停止）。

ABSTRACT Tobacco is the leading cause and alcohol is the third leading cause of preventable death and disability in the U.S. Almost one-third of all cancers are directly attributable to smoking, and alcohol increases the risk for cancers of the mouth, pharynx, larynx, esophagus, liver, colon, rectum, and breast. Moreover, the concomitant use of tobacco and alcohol synergistically increases the risk for some cancers (e.g., head and neck). Not only are tobacco and alcohol use major public health problems in their own right, they are closely linked behaviors. Smokers are much more likely to drink than are non-smokers and the prevalence of problem drinking is much higher among smokers than among nonsmokers. Unfortunately, tobacco and alcohol use are major public health problems in Puerto Rico (PR). Although the prevalence of smoking among Puerto Ricans living in PR is lower (12.5%) than in the continental U.S. (20.6%), the five leading causes of death in PR are associated with smoking (i.e., heart disease, cancer, stroke, hypertension and chronic pulmonary disease). Similarly, although Puerto Ricans are less likely to drink than is either the general population of the U.S. or Hispanics in the U.S., they are more likely to be binge drinkers if they do drink (http://www.cdc.gov/brfss/). Furthermore, the negative health consequences of alcohol and tobacco are not confined strictly to heavy or abusive use. For example, the risk for each of the alcohol-related cancers increases substantially with alcohol consumption of more than two drinks per day for men, and one drink per day for women. In fact, a landmark report from the Institute of Medicine (IOM) identified "at risk" drinking (chronic moderate to heavy levels of use, binge drinking, or drinking and driving) as a serious public health concern because it is associated with numerous other negative health and social consequences, as well as cancer. Therefore, the IOM recommended integrating screening, prevention, and treatment of at risk drinking into public health settings. Thus, a critical strategy for cancer risk reduction among Puerto Rican smokers is reducing the use of these two substances. The proposed study is a randomized clinical trial that will evaluate the efficacy of a unique, theoretically- and empirically-based "Motivation and Problem-Solving" (MAPS) approach to treating tobacco and at risk alcohol use in a population-based, public health setting. MAPS is a treatment approach that combines attributes of both motivational interviewing and cognitive behavioral/problem-solving treatment approaches. Participants are Puerto Rican smokers who are also "at risk" drinkers, and who call the Puerto Rico Quitline (PRO) for smoking cessation counseling. At risk drinking, as defined by the National Institute on Alcohol Abuse and Alcoholism, refers to a constellation of alcohol use behaviors that increase risk for physical and psychosocial problems. Our previous research among smokers calling the PRO indicates that 36% are at risk drinkers. Participants (N=200) will be randomly assigned to either a MAPS treatment with a focus on smoking cessation, or a MAPS+ condition that focuses on smoking cessation and the reduction of at risk alcohol use. Treatment is telephone-based, and designed to be easily disseminated to health care systems and other population-based settings for tobacco and alcohol control. The primary outcome variable is at risk drinking. We hypothesize that MAPS+ will reduce at risk alcohol use behaviors relative to MAPS. Although we will also examine smoking cessation as an outcome, we believe that there will be no difference between MAPS and MAPS+ with respect to smoking cessation outcomes. Although Ml and cognitive behavioral/problem-solving approaches have a relatively long history in the treatment of alcohol use and smoking cessation, to the best of our knowledge, this study would be the first to apply a motivational enhancement approach to concomitantly treating smoking and alcohol use. It is important to note that the goal of MAPS+ is not necessarily to promote abstinence from alcohol, but to modify at risk drinking behaviors. The specific aims of this project are to: 1. Evaluate MAPS and MAPS+ effects on at risk alcohol use (and smoking cessation) among Puerto Rican smokers who are also at risk drinkers. 2. Assess MAPS and MAPS+ effects on treatment mechanisms and the role of those mechanisms in mediating treatment effects on at risk drinking (and smoking cessation). 3. Evaluate the cost-effectiveness of MAPS and MAPS+ in the reduction of at risk drinking (and smoking cessation).