Enhancing cancer outreach for low-income adults with innovative smoking cessation

描述(由申请人提供)：最近的证据表明，目前美国成年人吸烟的流行率已降至20%以下。虽然这一下降是令人鼓舞的，但在美国，吸烟仍然是可预防的发病率和死亡率的主要原因。此外，某些人口群体的吸烟率要高得多，例如教育程度低的人群和生活在贫困线或以下的人群。因此，努力以这些服务不足的人群为目标进行有效的戒烟治疗是一项至关重要的公共卫生努力。这项分组随机试验的首要目标是设计和评估一种针对未参保和参保不足的个人的新型戒烟计划。拟议研究的主要内容将是利用已建立的社区网站网络(例如，社区中心和教堂)和一个流动单位，使我们能够接触到在使用更传统的戒烟治疗方法方面面临重大障碍的个人。 这项研究的具体目标是：1)在一项分组随机试验中，比较针对社区低收入、未参保和参保不足的个人的三种戒烟干预措施的效果。干预措施将包括标准护理(SC)方法，包括戒烟的简短建议、尼古丁替代疗法(NRT)和自助书面材料；增强护理(EC)方法，包括标准护理组成部分加上单一健康反馈和激励性访谈咨询会议和手机发送的文本/图形消息部分；以及重症监护(IC)方法，包括所有SC和EC部分以及一系列11次手机提供的积极咨询会议和手机提供的文本/图形消息部分；2)评估戒烟动机、尼古丁戒断、风险认知、自我效能、社会支持和负面情绪作为潜在的戒烟中介因素的作用；3)比较三种治疗条件的成本-效果。 我们认为，在这三个条件中，IC将最成功地满足低收入吸烟者的需求，原因有几个。首先，IC计划将个性化、个性化，并配备通过手机提供的密集、扩展的咨询和支持模块。其次，该计划将结合三个干预组成部分，具有保持支持和戒烟动机的高潜力，并防止复发。第三，IC干预利用了手机技术--在调查小组之前进行的研究中，这种方法在低收入吸烟者中证明了可行性和有效性。拟议的研究提供了一些特点(服务靠近居住地、提供手机等)。这可能会减少治疗障碍，同时加强参与者的招募和留住。 公共卫生相关性：这项拟议的研究将利用现有的社区网站网络和一个移动单位，为居住在德克萨斯州大休斯顿的多种族人口提供戒烟治疗，这些人口包括没有保险和保险不足的成年人。这些治疗将包括一些组成部分，如戒烟的简短建议、尼古丁贴片、书面材料、励志访谈/健康反馈咨询、短信/PIX消息和积极的手机咨询。

DESCRIPTION (provided by applicant): Recent evidence indicates that the prevalence of current cigarette smoking among adults in the US has dropped below 20%. While this drop is encouraging, smoking still represents the leading cause of preventable morbidity and mortality in the US. Moreover, smoking prevalence is significantly higher among certain population groups, such as those with low levels of education and those living at, or below the poverty level. Therefore, efforts to target these underserved populations with efficacious smoking cessation treatments represents a vital public health effort. The overarching goal of this group-randomized trial is to design and evaluate a novel smoking cessation program targeted to uninsured and underinsured individuals. Key elements of the proposed study will be the use of an established network of community sites (e.g., community centers and churches) and a mobile unit, enabling us to reach individuals confronted with significant barriers to utilizing more traditional smoking cessation treatment approaches. Specific aims of the study will be to: 1) Compare the efficacy of three smoking cessation interventions targeting community based low income uninsured and underinsured individuals in a group-randomized trial. The interventions will include a Standard Care (SC) approach, consisting of brief advice to quit smoking, nicotine replacement therapy (NRT), and self-help written materials; an Enhanced Care (EC) approach, consisting of the standard care components plus a single health feedback and motivational interviewing counseling session and a cell phone-delivered text/graphical messaging component; and an Intensive Care (IC) approach, consisting of all SC and EC components plus a series of 11 cell phone-delivered proactive counseling sessions and a cell phone-delivered text/graphical messaging component; 2) Evaluate the role of quit motivation, nicotine withdrawal, risk perception, self- efficacy, social support, and negative affect as potential mediators of smoking abstinence; and 3) Compare the cost-effectiveness of the three treatment conditions. We believe that of the three conditions, the IC will most successfully address the needs of low-income smokers for several reasons. First, the IC program will be personalized, individualized, and equipped with an intensive, extended counseling and support module provided over the cell phone. Second, the program will combine three intervention components featuring high potential for maintaining support and motivation to quit and prevent relapse. Third, the IC intervention makes use of cell phone technology - an approach that has demonstrated feasibility and efficacy among low-income smokers in previous research conducted by the investigative team. The proposed study offers a number of features (proximity of services to the place of residence, provision of cell phones, etc.) that are likely to reduce treatment barriers while enhancing participant recruitment and retention. PUBLIC HEALTH RELEVANCE: The proposed study will use an existing network of community sites and a mobile unit to deliver smoking cessation treatment to a multiethnic population of uninsured and underinsured adults living in the greater Houston, Texas metropolitan area. The treatments will include components such as brief advice to quit, nicotine patch, written materials, motivational interviewing/health feedback counseling, text/pix messaging, and proactive cell phone counseling.