Health Advocates as a Vehicle to Improve Treatment for Smokers in Public Housing

描述（由申请人提供）：戒烟是吸烟者可以采取的最重要的一步，以有益于他们的健康。然而，低收入吸烟者戒烟的成功率低于高收入吸烟者。如果吸烟和戒烟率的社会经济差异持续下去，低收入吸烟者将承受越来越大的吸烟相关发病率和死亡率的负担。因此，迫切需要采取干预措施，提高低收入吸烟者的戒烟率。戒烟治疗计划，如电话戒烟热线和诊所为基础的计划存在，但未得到充分利用，特别是低收入吸烟者。我们建议在公共住房居民中进行一项分组随机试验，以测试使用经过戒烟专门培训的居民社区健康倡导者（烟草治疗倡导者（TTAs））是否可以提高（1）戒烟热线和诊所计划的利用率以及（2）公共住房吸烟者的戒烟率。波士顿的20个公共住房开发项目将被随机分配接受TTA干预或加强标准护理，每种情况招募250名吸烟者。每位参与者的干预期将持续6个月，6个月后进行最终结果评估。在干预阶段，PHD和TTA将与吸烟者进行7-9次互动，以激励他们使用治疗计划，帮助确定最符合其需求的计划，主动将吸烟者与计划联系起来，解决后勤问题和其他参与计划的障碍，加强和增加咨询信息，鼓励充分利用计划，包括坚持用药，并为治疗期间和治疗后的戒烟提供社会支持。对照PHD的参与者将与TTA会面一次，TTA将为他们提供文化上适当的自助材料和通过Quitline和基于诊所的计划提供的戒烟服务信息。研究的主要结局将是（1）Quitline或基于诊所的戒烟服务（包括治疗剂量）的使用，以及（2）在3、7和12个月时测量的7天和30天经生化验证的戒烟率。结局的数据来源以及假设的中介者和调节者将包括戒烟热线和诊所记录、TTA记录和在四个时间点进行的问卷调查。对每增加一次戒烟的成本进行成本效益评价，将提供关于推广潜力的信息。 公共卫生相关性：戒烟是吸烟者可以采取的有益健康的最重要步骤，但低收入吸烟者戒烟的成功率低于高收入吸烟者。迫切需要采取干预措施，提高低收入吸烟者的戒烟率，否则这些吸烟者将承担越来越多的与吸烟有关的疾病和死亡负担。利用公共住房等低收入社区的居民帮助其他居民戒烟可能是提高戒烟率的有效方法。

DESCRIPTION (provided by applicant): Quitting smoking is the most important step that smokers can take to benefit their health. However, low-income smokers are less successful in quitting than higher-income smokers. If these socioeconomic disparities in smoking and smoking cessation rates persist, low-income smokers will bear an increasingly disparate burden of smoking-related morbidity and mortality. Therefore, interventions to improve the rate of smoking cessation among low-income smokers are urgently needed. Smoking cessation treatment programs such as telephone quitlines and clinic-based programs exist but are underutilized, particularly by low-income smokers. We propose to conduct a group-randomized trial among public housing residents to test whether the use of resident Community Health Advocates with special training in smoking cessation (Tobacco Treatment Advocates (TTAs) can improve (1) utilization of quitlines and clinic-based programs and (2) smoking cessation rates among smokers in public housing. Twenty public housing developments (PHDs) in Boston will be randomly assigned to receive either the TTA intervention or enhanced standard care, with 250 smokers recruited for each condition. The intervention period for each participant will last 6 months, with final outcome assessment 6 months later. At intervention PHDs and TTAs will have 7-9 interactions with smokers to motivate them to use a treatment program, assist in determining which program best meets their needs, proactively connect smokers to programs, address logistical problems and other barriers to program participation, reinforce and augment counseling messages, encourage full utilization of programs including adherence to medication, and provide social support for quitting during and after treatment. Participants at control PHDs will meet once with a TTA who will provide them with culturally-appropriate self-help materials and information on smoking cessation services available through the Quitline and clinic-based programs. The primary outcomes for the study will be (1) utilization of Quitline or clinic-based cessation services (including dose of treatment), and (2) 7-and 30-day biochemically-verified smoking abstinence measured at 3, 7, and 12 months. Data sources for outcomes, as well as hypothesized mediators and moderators, will include quitline and clinic records, TTA records, and questionnaires administered at four time points. A cost-effectiveness evaluation of the cost per additional quit will provide information on the potential for disseminability. PUBLIC HEALTH RELEVANCE: Quitting smoking is the most important step that smokers can take to benefit their health, but low-income smokers are less successful in quitting than higher-income smokers. Interventions to improve the rate of smoking cessation among low-income smokers are urgently needed, or else these smokers will bear an increasingly disparate burden of smoking-related disease and death. Using residents from low-income communities, such as public housing, to help their fellow residents quit smoking may be an effective method to increase the rate of smoking cessation.