Technological Innovations in a Behavioral Treatment for Cigarette Smoking

摘要/摘要在发达国家，吸烟是导致发病率和死亡率的最大可预防的危险因素。尽管美国公共卫生服务局（the United States Public Health Service）支持各种药物疗法和戒烟咨询，但大多数患者在六个月内复吸，即使两种疗法同时使用也是如此。当前干预措施的局限性突出表明迫切需要创新、有力和社区友好的治疗方法。禁欲强化疗法就是这样一种治疗方法。我们开发和测试了一个基于互联网的监测系统，通过呼气一氧化碳（CO）的输出来验证和加强戒烟。通过使用这种简单而创新的方法，我们发现患者高度参与治疗，并且在一组重度吸烟者中，凭证强化产生了高持续戒断率（治疗期间400个CO样本中超过65%为阴性）。在拟议的项目中，我们将评估一个广泛适用的，可持续的，临床可行的禁欲强化干预。治疗交付模式将互联网的可及性和便利性与最先进的经验衍生的吸烟行为治疗相结合。吸烟者将被随机分配到戒烟强化组或对照组，并在治疗期间和6个月的随访中测量吸烟状况。在尝试戒烟的最初几周内，治疗可以不间断地继续进行，越来越多的证据表明，这是促进长期戒烟的关键时期。为了补充我们个性化的用户友好的CO测量技术，并使治疗对参与者更加个性化，我们将纳入押金合同程序。参与者将提供一定数额的钱，他们可以根据禁欲的证据收回这笔钱。这种方法有望大大抵消与治疗相关的费用。最后，我们将采用远程治疗交付模式，这样距离就不会成为障碍。这种治疗方法可以推广到美国任何一个合格的吸烟者。拟议的方案具有创新性，直接解决了传统节欲强化交付模式固有的一些主要限制（成本、可持续性、可及性），具有广泛传播的吸引力和可行性。如果干预的承诺得以实现，它将降低与吸烟有关的高发病率和死亡率。

DESCRIPTION (provided by applicant): Technological Innovations in a Behavioral Treatment for Cigarette Smoking Project Summary/Abstract Cigarette smoking is the largest preventable risk factor for morbidity and mortality in developed countries. Although the United States Public Health Service endorses various pharmacotherapies and counseling for smoking cessation, the majority of patients relapse within six months, even when both treatments are used together. The limitations of current interventions highlight the urgent need for innovative, powerful, and community-friendly treatments. Abstinence reinforcement therapy is one such treatment. We developed and tested an internet-based monitoring system to verify and reinforce smoking abstinence by breath carbon monoxide (CO) output. By using this simple yet innovative method, we found that patients were highly engaged with the treatment, and that voucher reinforcement produced high rates of sustained abstinence in a group of heavy smokers (over 65% of the 400 CO samples were negative during treatment). In the proposed project, we will evaluate a broadly applicable, sustainable, and clinically feasible abstinence reinforcement intervention. The treatment delivery model integrates the reach and convenience of the internet with a state-of-the-art, empirically-derived behavioral treatment for cigarette smoking. Smokers will be randomly assigned to an abstinence reinforcement group or to a control group, and smoking status will be measured during treatment and at a 6-month follow-up. Treatment can continue uninterrupted during the initial weeks of a quit attempt, which growing evidence suggests is a critical period to promote long-term cessation. To complement our individualized user-friendly CO measurement technology and make the treatment even more personally salient to participants, we will incorporate a deposit contract procedure. Participants will contribute a specified amount of money that they can recoup based on evidence of abstinence. This method holds promise as a way to substantially offset the costs associated with treatment. Finally, we will employ a remote treatment delivery model such that distance will not be a barrier. The treatment can be disseminated to any qualified smoker in the United States. The proposed program is innovative and directly addresses some of the major limitations (cost, sustainability, access) inherent in traditional abstinence reinforcement delivery models, and it has the potential to be appealing and feasible for widespread dissemination. If the promise of the intervention is realized, it will reduce the high rates of morbidity and mortality associated with smoking. PUBLIC HEALTH RELEVANCE: Technological Innovations in a Behavioral Treatment for Cigarette Smoking Public Health Relevance Statement Cigarette smoking is the largest preventable risk factor for morbidity and mortality in the United States. The proposed treatment will integrate the reach and convenience of the internet with a state-of-the-art, empirically-derived behavioral treatment for cigarette smoking: abstinence reinforcement therapy. The current program is innovative and directly addresses some of the major limitations (cost, sustainability, dissemination) inherent in traditional abstinence reinforcement delivery models. The intervention has the potential to be appealing and feasible for widespread dissemination. As such, this technological innovation in a behavioral treatment for cigarette smoking holds significant promise as a way to reduce the high rates of morbidity and mortality associated with smoking.