Strategies To Promote Cessation in Smokers Who Are Not Ready To Quit

 描述(申请人提供)：几乎所有的戒烟干预都是针对那些表示愿意戒烟的吸烟者进行的。对于目前还没有准备好戒烟的吸烟者(例如，不是在接下来的30天内)，帮助吸烟者的方法研究得更少。尽管大多数吸烟者在任何给定的时间点都没有准备好戒烟，但关于没有准备好戒烟的吸烟者的研究仍然很少。虽然近69%的吸烟者想在未来某个时候戒烟，但只有不到10%的吸烟者准备在未来30天内认真尝试戒烟。在不准备戒烟(SNRTQ)的吸烟者中，有两种不同的方法来提高戒烟率。第一种方法是以“5RS”为基础的激励性面试(MI)(相关性、风险、回报、障碍、重复)。然而，只有一项十年前的研究用SNRTQ评估了MI的影响-MI产生的戒烟尝试和戒烟次数都高于a)使用尼古丁替代疗法的减量咨询加上简单的建议，以及b)不治疗。第二种方法结合了行为/药物率降低，作为一种减少烟草使用以及提高戒烟自我效能的方法。在SNRTQ中，联合行为/药物率降低已被证明是戒烟几率的两倍以上。据我们所知，还没有研究评估MI和降低率单独或联合使用对刺激SNRTQ增加戒烟尝试和烟草戒断的独立影响。因此，我们提出了以下具体目标：(1)测试SNRTQ的戒烟热线；(2)将2100个SNRTQ随机分为：(A)简短建议+典型戒烟资源(对照组)；(B)采用临床实践指南推荐的5RS(MI/5RS)形式的激励性访谈；(C)综合行为和药理学比率降低，以及(D)MI/5RS+联合行为和药理学比率降低。此设计使我们能够评估MI和减低率对戒烟尝试和戒烟的独立和相加的影响；(3)评估干预的效果。主要终点是干预后6个月(随机化后12个月)的时点患病率。干预后6个月的长期戒烟和2、4、6个月的戒烟尝试以及干预后6个月的随访是次要的终点；(4)确定每个干预措施的成本效益(每戒烟者的成本)。目前的提案针对SNRTQ服务不足的人群，具有非常重要的意义，具有创新性，并对公共卫生产生巨大影响。

 DESCRIPTION (provided by applicant): Virtually all smoking cessation interventions have been conducted on smokers who indicate a willingness to quit smoking. Much less well-studied are approaches for assisting smokers who are not ready to quit smoking at the current time (ex., not in the next 30 days). The paucity of research on smokers not ready to quit smoking is present despite the fact that the majority of smokers are not ready to quit smoking at any given point in time. While almost 69% of smokers want to quit at some time in the future, fewer than 10% of smokers are ready to make a serious smoking cessation attempt in the next 30 days. There have been two different approaches towards increasing cessation rates in smokers not ready to quit (SNRTQ). The first approach Motivational Interviewing (MI) using "5Rs"as a foundation (Relevance, Risks, Rewards, Roadblocks, Repetition). However, only one study, which is a decade old, has evaluated the impact of MI with SNRTQ - with MI producing both higher quit attempts and smoking cessation than a) reduction counseling using nicotine replacement therapy plus brief advice alone and b) no treatment. The second approach combined behavioral/pharmacological rate reduction as an approach to produce reductions in tobacco use as well as to enhance self-efficacy for smoking cessation Combined behavioral/pharmacologic rate reduction has been shown to more than double the odds of cessation in SNRTQ. To our knowledge, no study has evaluated the independent effects of MI and Rate Reduction, individually versus in combination, for motivating SNRTQ to increase both quit attempts and tobacco abstinence. Thus, we propose the following Specific Aims: (1) To test a tobacco Quit Line for SNRTQ; (2) To randomize 2100 SNRTQs to: (a) Brief Advice + typical smoking cessation resources (control group); (b) Motivational Interviewing using the 5Rs (MI/5Rs) format recommended by the Clinical Practice Guidelines; (c) Combined behavioral and pharmacologic Rate Reduction, and (d) both MI/5Rs + combined behavioral and pharmacologic Rate Reduction. This design allows us to evaluate the independent and additive effects of MI and Rate Reduction on quit attempts and smoking cessation; (3) to evaluate the efficacy of the intervention. The primary endpoint will be point prevalence at the 6-month post-intervention follow-up (12 months after randomization). Prolonged abstinence at the 6-month post intervention follow-up and quit attempts at the 2-, 4- and 6-month and the 6-month post intervention follow-up are secondary endpoints, and; (4) To determine the cost effectiveness (cost per quit smoker) of each of the interventions. The current proposal addresses the underserved population of SNRTQ is highly significant, innovative, and has a tremendous public health impact.