Project 4: Longitudinal Care; smoking reduction to aid cessation

背景资料。超过75%的吸烟者报告说他们想戒烟，但每年成功实现长期戒烟的不到10%。人们将烟草依赖的慢性性质与糖尿病等其他医疗疾病相提并论，然而，目前对吸烟者的护理模式没有纳入慢性病管理的原则。目标。本项目的目的是进行一项随机对照试验，比较1)为期一年的纵向护理戒烟治疗(LC)和2)离散间歇性戒烟治疗(DC)，以确定IFLC改善长期戒烟的效果。方法：研究方法。440名有意戒烟的吸烟者将被登记并 随机分配到LC或DC组。这两组人最初都将接受最先进的戒烟干预，包括行为和药物成分，通过面对面和电话护理相结合的方式提供。未能戒烟、戒烟次数减少但没有戒烟或复发的LC参与者将在接下来的12个月内接受强化治疗，鼓励他们重复戒烟尝试，如果他们还没有准备好戒烟，就减少吸烟。我们建议将减量作为LC的中间目标，因为这可能会增加戒烟的可能性，提高自我效能，并保持吸烟者和临床医生的投入。还原处理 将包括行为治疗和尼古丁替代。DC参与者只会收到偶尔的退出提示。主要终点将是在登记后18m测量的6m禁欲。次要终点将包括普遍存在的戒烟、减少吸烟、自我效能和满足感。我们还将从成功的戒酒者和节约者那里收集有关决策过程和干预经验的定性数据。意义重大。该项目将针对有意戒烟的吸烟者，在治疗菜单中阐述减少吸烟的潜在作用。该项目与Hatsukami博士和彭特尔博士的建议一起，研究了减少毒素暴露的机制、方法和“现实世界”的应用。

Background. More than 75% of smokers report that they would like to quit but each year less than 10% successfully achieve long-term abstinence each year. The chronic nature of tobacco dependence has been compared to other medical disorders such as diabetes, however current models of care for smokers do not incorporate principles of chronic disease management. Objective. The obj ective of this project is to conduct a randomized controlled trial to compare 1) a longitudinal care smoking cessation treatment delivered over a one-year period (LC) to 2) discrete episodic smoking cessation treatment (DC) to determine ifLC improves prolonged smoking abstinence. Methods. 440 smokers who are interested in quitting will be enrolled and randomly assigned to the LC or DC groups. Both groups will initially receive a state-of-the-science smoking cessation intervention including behavioral and pharmacological components, delivered by a combination of in-person and telephone care. LC participants who fail to quit, reduce but do not quit, or relapse will receive intensive treatment over the ensuing 12 months that encourages repeat quit attempts and smoking reduction if they are not ready to quit. We propose reduction as an intermediate goal in LC because this may increase the likelihood of cessation, increase self-efficacy and keep smokers and clinicians engaged. Reduction treatment will include behavioral treatment and nicotine replacement. DC participants will only receive occasional prompts to quit. The primary endpoint will be 6M of abstinence measured 18M after enrollment. Secondary endpoints will include point prevalent abstinence, smoking reduction, self-efficacy and satisfaction. We will also collect qualitative data from successful abstainers and reducers about decision making processes and intervention experiences. Significance. This project will address the potential role of smoking reduction in the treatment menu for smokers interested in quitting. This project, together with the Dr. Hatsukami and Dr. Pentel's proposals, examine mechanisms, methods and a "real world" application for reducing toxin exposure.