Evaluation of Tobacco Treatment Strategies for Inpatient Psychiatry

描述(由申请人提供)：这项研究的总体目标是确定治疗严重精神疾病住院的成年吸烟者烟草依赖的有效策略。尼古丁依赖是精神病患者中最常见的物质滥用障碍，这一群体占美国烟草市场16，17的44%至46%，令人震惊。就花费的美元而言，这相当于每年390亿美元的烟草销售额18。虽然许多试验已经确定了戒烟干预对住院内科患者的有效性，但很少有研究针对急性精神病住院患者19。美国精神病学协会的烟草治疗指南将精神科住院确定为促进戒烟的理想机会1。与普通人群20-22相比，精神病患者的戒烟率更低，在不久的将来戒烟的动力和准备可能更小。因此，需要足够强烈的多成分干预措施，解决尼古丁依赖的生理和行为方面的问题，并通过戒烟过程帮助处于戒烟准备阶段的吸烟者23。采用三组相加设计，建议的随机临床试验(N=1100)旨在评估在急性精神科住院患者中开始的不同强度的戒烟治疗。该申请建立在普罗查斯卡博士的K23指导职业发展奖的基础上，并试图确定：(I)在以学术为基础的精神科医院看到的初步成功是否可以在从社区医院招募的更大和更多样化的患者群体中复制；以及(Ii)更广泛和更密集的临床医生提供的治疗是否可以超越我们目前的最佳实践。这三组患者是：(1)常规治疗(N=150)，包括简短的戒烟建议、戒烟指南和住院期间提供的尼古丁替代治疗；(2)短暂治疗(N=475)增加了基于阶段的手册、计算机提供的个体化个体化反馈和短暂的戒烟咨询会议，在住院期间重复进行，并在住院后3个月和6个月重复，并在住院后获得12周的尼古丁替代治疗；(3)扩大治疗(N=475)在我们目前的简短治疗的基础上，额外提供12周的尼古丁替代治疗(共24周)，并提供个性化、辅导员提供的激励性和手动的认知行为戒烟治疗。我们假设延长治疗将比短期治疗效果更好，并且两个治疗组在产生戒烟尝试和最终戒烟方面都将比通常的治疗更有效。次级目标将模拟治疗条件的成本效益；检查治疗结果的调节因素和中介因素；并前瞻性地检查吸烟、心理健康功能和其他物质使用随时间的变化之间的关系。公共卫生相关声明：在美国，患有精神疾病的人平均过早死亡25岁，与烟草相关的心血管和肺部疾病以及癌症被确定为主要原因24。尽管吸烟率高，戒烟率低，对健康造成破坏性影响，但对患有精神疾病的吸烟者的临床治疗研究仍然有限。本研究旨在通过一项随机对照试验，对社区医院急性精神科住院的吸烟者进行不同强度的烟草治疗。

DESCRIPTION (provided by applicant): The overall goal of this research is to identify efficacious strategies for treating tobacco dependence among adult smokers hospitalized with severe mental illness. Nicotine dependence is the most prevalent substance abuse disorder among psychiatric patients, a group that accounts for a staggering 44% to 46% of the US tobacco market16, 17. In terms of dollars spent, this equates to $39 billion in annual tobacco sales18. While numerous trials have established the effectiveness of smoking cessation interventions for hospitalized medical patients, little research has targeted the acute psychiatric inpatient setting19. The American Psychiatric Association's tobacco treatment guidelines identify psychiatric hospitalization as an ideal opportunity for promoting smoking cessation1. Individuals with mental illness have lower quit rates and may be less motivated and prepared to quit in the near future than the general population20-22. Thus, sufficiently intense, multi- component interventions are needed that address both the physiological and behavioral aspects of nicotine dependence and assist smokers at all stages of readiness through the quitting process23. Using a three group additive design, the proposed randomized clinical trial (N=1100) aims to evaluate tobacco cessation treatments of varying intensities initiated in the acute psychiatric inpatient setting. The application builds upon Dr. Prochaska's K23 mentored career development award and seeks to determine: (i) whether the initial successes seen in an academic-based psychiatric hospital can be replicated in a larger and more diverse patient population recruited from a community hospital; and (ii) if more extended and intensive clinician-delivered treatment can outperform our current best practices. The three groups are: (1) Usual Care (N=150) consisting of brief cessation advice, a quit smoking guide, and nicotine replacement provided during hospitalization; (2) Brief Treatment (N=475) adds a stage-based manual, computer-delivered stage-tailored individualized feedback and brief cessation counseling sessions during hospitalization and repeated at months 3 and 6, and access to 12 weeks of nicotine replacement following hospitalization; (3) Extended Treatment (N=475) builds upon our current brief treatment and provides 12 additional weeks of nicotine replacement (24 weeks total) with individualized, counselor-delivered motivational and manualized cognitive behavioral cessation treatment. We hypothesize that the extended treatment will outperform the brief treatment, and that both treatment groups will be more effective than usual care in producing quit attempts and ultimately abstinence from cigarettes. Secondary aims will model the cost-effectiveness of the treatment conditions; examine moderators and mediators of treatment outcomes; and prospectively examine the relation between changes in smoking, mental health functioning, and use of other substances over time. Public Health Relevance Statement: Individuals with mental illness in the US are dying, on average, 25 years prematurely, with tobacco-related illnesses of cardiovascular and lung disease and cancer identified as chief causes24. Despite the high prevalence of smoking, low rates of quitting, and devastating health effects, clinical treatment research with smokers with mental illness remains limited. This study aims to evaluate, in a randomized controlled trial, tobacco treatments of varying intensities for smokers hospitalized on acute psychiatric inpatient units in a community hospital.