Optimizing remotely delivered Smoking Cessation Services for Low-Income Smokers

摘要 吸烟是导致癌症和许多其他致命疾病的主要可预防原因， 在社会经济资源有限的人群中，吸烟率最高。虽然我们已经开车 人口吸烟率，并与他们，癌症发病率，大约28%的社会经济弱势群体 仍然经常吸烟。低收入（L-I）吸烟者患癌症的几率也更高，戒烟的难度也更大 比高收入的吸烟者要多。必须解决烟草使用及其负担方面的这些差异。高度 有效的戒烟治疗服务，可以远程、灵活、方便地提供，成本低 或后勤障碍有可能实现这一目标。烟草戒烟热线和SmokefreeTXT服务 这些治疗资源在L-I吸烟者中具有明显的吸引力和影响力。当前 建议将使用有效的析因设计来评估4种戒烟干预措施， 传播潜力。目标人群将是N= 1，408名符合医疗补助条件或无保险的吸烟者， 最近参加了威斯康星州戒烟热线（WTQL），但报告继续吸烟4- 参与标准WTQL服务后数月。这些治疗无应答者将被邀请 参加一项实验，将他们随机分为以下4个因素中的每一个的2个水平中的1个， 2X2 X2 X2设计：WTQL咨询强度（1次与4次），药物强度（2周尼古丁 贴剂单药治疗与4周尼古丁贴剂和锭剂联合治疗），支持性短信 计划（SmokefreeTXT vs. none）和经济激励（治疗参与奖励高达150美元 vs.无治疗激励措施）。主要结果将是26周生化证实的点患病率 禁欲分析将检查这4种治疗成分对26- 30岁儿童的主要和交互作用。 一周和二次禁欲结果，以确定组件和组件的组合， 显著提高这一高危人群戒烟成功率。这个实验将特别确定 将成本适中、可扩展性强的干预措施和可用于 在全国范围内传播，以减少那些寻求戒烟的人在戒烟方面的社会经济差异， 不干了其他分析将：比较干预措施的组成部分和有希望的组成部分组合， 就成本效益而言，检查各组成部分的治疗参与是否不同 组合，检查可能调节治疗反应的基线变量，并确定 治疗对戒断结局的影响。因为研究干预的交付可以集中进行， 通过建立和有效的服务（WTQL和SmokefreeTXT）， 测试的干预措施的传播和成本效益都很好。拟议的研究将有助于 确定减少L-I吸烟者戒烟差异的方法， 复发，并可能受益于改善援助。

ABSTRACT Cigarette smoking is the leading preventable cause of cancer and many other deadly diseases, and the burden of tobacco use is greatest among those with limited socioeconomic resources. Although we have driven down population smoking rates, and with them, cancer rates, roughly 28% of the socioeconomically disadvantaged still smoke regularly. Low-income (L-I) smokers also develop cancer at higher rates and struggle more to quit than do higher-income smokers. These disparities in tobacco use and its burdens must be addressed. Highly effective cessation treatment services that can be delivered remotely, flexibly, and conveniently with few cost or logistical barriers have the potential to achieve this aim. Tobacco quitline and SmokefreeTXT services are such treatment resources with demonstrated attractiveness and reach among L-I smokers. The current proposal will use an efficient factorial design to evaluate 4 smoking cessation interventions with vast reach and dissemination potential. The target population will be N=1,408 Medicaid-eligible or uninsured smokers who have recently enrolled in the Wisconsin Tobacco Quit Line (WTQL), but who report continued smoking 4- months following engagement in standard WTQL services. These treatment non-responders will be invited to participate in an experiment that will randomize them to 1 of 2 levels of each of the following 4 factors in a 2X2X2X2 design: WTQL counseling intensity (1 session vs. 4 sessions), medication intensity (2-week nicotine patch monotherapy vs. 4-week nicotine patch and lozenge combination therapy), a supportive text messaging program (SmokefreeTXT vs. none), and financial incentives (rewards of up to $150 for treatment engagement vs. no treatment incentives). The primary outcome will be 26-week biochemically confirmed point-prevalence abstinence. Analyses will examine the main and interactive effects of these 4 treatment components on 26- week and secondary abstinence outcomes to identify the components and combinations of components that significantly enhance success in quitting in this high-risk population. This experiment will identify especially effective combinations of highly scalable interventions of modest cost and few barriers that could be disseminated nationally to reduce socioeconomic disparities in smoking cessation among those seeking to quit. Additional analyses will: compare intervention components and promising component combinations in terms of cost-effectiveness, examine whether or not treatment engagement differs across component combinations, examine baseline variables that may moderate treatment response, and identify mediators of treatment effects on abstinence outcomes. Because delivery of the study interventions can be centralized through established and efficient services (WTQL and SmokefreeTXT), the potential for both scalable dissemination and cost-effectiveness of the interventions tested is great. The proposed research will help identify ways to reduce tobacco cessation disparities in L-I smokers who have tried to quit smoking but relapsed and may benefit from improved assistance.