A Personalized mHealth Approach to Smoking Cessation for Veterans Living with HIV

为感染艾滋病毒的退伍军人提供个性化的戒烟移动医疗方法

基本信息

批准号：
10477043
负责人：
Sarah Mosher Wilson
金额：
--
依托单位：
DURHAM VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-01 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10477043
关键词：
Abstinence Aging Algorithms Behavioral Cessation Research Clinic Clinical Cognitive Cohort Studies Computer software Counseling Data Ethnic Origin Feedback Funding Future HIV HIV Seropositivity Health Health Services Hepatitis C co-infection Hybrids Individual Intervention Interview Knowledge Libraries Measures Medical Methods Mobile Health Application Morbidity - disease rate Motivation Outcome Pain Patients Persons Pharmacotherapy Phase Population Population Intervention Preparation Provider Psychological reinforcement Quality of life Randomized Research Research Personnel Risk Smoke Smoker Smoking Smoking Cessation Intervention Structure Surveys Technology Testing TimeLine Training Treatment Efficacy Veterans Veterans Health Administration Woman acceptability and feasibility base behavioral pharmacology career clinical care clinical trial implementation cohort comorbidity computer program computerized contingency management design disorder later incidence prevention effectiveness implementation design effectiveness testing efficacious intervention efficacy testing evidence base experience feasibility testing feasibility trial financial incentive follow-up health disparity implementation science improved individualized medicine innovation intervention cost mHealth mobile computing mortality multi-component intervention person centered personalized approach personalized intervention personalized medicine portability preference programs quitline satisfaction smartphone Application smoking abstinence smoking cessation smoking prevalence stakeholder perspectives telehealth therapy design therapy development tobacco abstinence treatment planning trend

项目摘要

Although smoking is a significant cause of damage to health and quality of life specifically for Veterans with human immunodeficiency virus (HIV), smoking cessation interventions for this population are lacking. Dr. Wilson’s proposed CDA-2 projects will develop and test a mobile health (mHealth) intervention called Mobile Contingency Management plus Evidence-Based Smoking Cessation for HIV-positive Veterans (MESH). The MESH intervention uses mHealth and telehealth technology to a) individually personalize smoking cessation counseling and pharmacotherapy, b) deliver reinforcement for smoking abstinence, and c) provide relapse- prevention messaging support. It is a personalized, tailored, multi-component intervention for smoking cessation specifically designed for Veteran smokers living with HIV. Specific aims are as follows: Aim 1: To qualitatively explore smoking cessation treatment preferences among Veteran smokers living with HIV, and to quantitively evaluate perspectives on relapse-prevention messages among Veterans and smokers living with HIV. We will complete N = 20 semi-structured interviews with VHA HIV patients (initial treatment tailoring phase) and subsequently complete N = 400 quantitative rapid online surveys (secondary user satisfaction data). Results will be used to refine design/content of the proposed intervention. Aim 2: To use a successive cohort design to develop and obtain patient feedback on an mHealth smoking cessation intervention that uses computerized algorithms to personalize treatment. We will collect qualitative data on 3 cohorts of n = 5 Veteran smokers with HIV. Results from each cohort will be iteratively used to modify the MESH treatment design/content/user experience. Aim 3: To determine the feasibility and acceptability of MESH. After finalizing design of the mHealth app, we will conduct a trial in which N = 30 Veteran smokers with HIV will be randomized to either MESH or to a comparison condition (VA Quitline and SmokefreeVET). Outcomes include feasibility of the overall approach and acceptability of the intervention. Tests of efficacy are not appropriate given power considerations and the overall focus on treatment development. Results will be used in an IIR application in Year 3 of the timeline. While the IIR design may change, I plan to propose a Hybrid Type 1 implementation-effectiveness design to test effectiveness of the MESH intervention while collecting preliminary clinic-level implementation data. Aim 4: To quantitatively examine trends and determine health disparities in use of smoking cessation aids among patients living with HIV and receiving VHA clinical care. I will leverage two large national VA cohorts to compare smoking cessation pharmacotherapy prescriptions by demographic group and medical comorbidity. I expect to detect disparities in pharmacotherapy prescription rates by medical comorbidity (e.g., pain, Hepatitis C coinfection) and demographic group (e.g., ethnicity). Results will enable future examination of whether MESH may help overcome existing disparities. This CDA-2 application is highly significant given that: 1) Smoking is prevalent among and particularly harmful for HIV-positive Veterans; 2) There is a dearth of research on smoking cessation for Veterans with HIV; 3) Current approaches to smoking cessation in this population are not efficacious; 4) As the largest U.S. provider of HIV health services, VHA is an ideal setting; and 5) The proposed intervention follows the VA Blueprint for Excellence, which prioritizes mHealth and treatment personalization to increase reach/efficacy. This CDA-2 application is innovative and unique in the following ways: 1) It is the first multi-component mHealth intervention for HIV-positive Veteran smokers that individually personalizes treatment; 2) Previous interventions have not attempted to maintain abstinence effects of behavioral reinforcement by offering relapse-prevention messaging; and 3) There is currently little knowledge of health disparities in VHA prescriptions for smoking cessation pharmacotherapy among Veterans with HIV.

尽管吸烟是对健康和退伍军人的健康和生活质量损害的重要原因由于人类免疫缺陷病毒（HIV），缺乏对该人群的戒烟干预措施。博士威尔逊提议的CDA-2项目将开发和测试移动健康（MHealth）干预措施，称为移动应急管理以及HIV阳性退伍军人（网格）的基于证据的戒烟。这网格干预使用MHealth和Telehealth技术来a）单独个性化戒烟咨询和药物治疗，b）提供戒烟的加强，c）提供救济 - 预防消息支持。这是一种个性化的，量身定制的多组分干预措施，用于吸烟戒烟专为艾滋病毒的退伍军人吸烟者而设计。具体目的如下：目的1：定性探索居住的退伍军人吸烟者的戒烟治疗偏好艾滋病毒，并定量评估退伍军人和艾滋病毒的吸烟者。我们将对VHA HIV患者（初始）完成N = 20个半结构化访谈治疗剪裁阶段），随后完成n = 400个定量快速在线调查（次要用户满意度数据）。结果将用于完善拟议干预措施的设计/内容。目标2：使用成功的队列设计来开发和获得有关MHealth的患者反馈使用计算机化算法来个性化治疗的戒烟干预措施。我们将收集 n = 5名艾滋病毒的老将吸烟者的3个同类群体的定性数据。每个队列的结果将是迭代的用于修改网格处理设计/内容/用户体验。目标3：确定网格的可行性和可接受性。最终设计MHealth之后应用程序，我们将进行一项试验，其中n = 30名艾滋病毒的退伍军人吸烟者将被随机分为网格或比较条件（VA Quitline和SmokeFreevet）。结果包括整体方法的可行性和干预的可接受性。给定功率考虑的效率测试不适合总体上关注治疗开发。结果将在时间表的第三年内使用IIR应用程序。虽然IIR设计可能会发生变化，但我计划将混合1型实施效果设计提出在收集初步诊所级实施数据时，网格干预的测试有效性。目标4：定量检查趋势并确定使用戒烟的健康分布艾滋病毒患者和接受VHA临床护理的患者中的艾滋病。我将利用两个大型国家弗吉尼亚州比较人口组和医疗的戒烟药物疗法处方的同类合并症。我希望通过医疗合并症检测药物治疗处方率的差异（例如，疼痛，丙型肝炎共同感染）和人口统计组（例如种族）。结果将使以后的检查网格是否可以帮助克服现有的分布。鉴于：1）吸烟是普遍的，尤其是对HIV阳性退伍军人有害； 2）关于退伍军人的戒烟研究死亡艾滋病病毒; 3）目前在该人群中停止戒烟的方法并非有效； 4）作为美国最大的 VHA的艾滋病毒卫生服务提供商是理想的环境； 5）拟议的干预措施遵循VA 卓越的蓝图，优先考虑MHealth和治疗个性化以提高触及/功效。此CDA-2应用程序是创新的，并且在以下方式中是独一无二的：1）它是第一个多组件 MHealth干预艾滋病毒阳性的退伍军人吸烟者，这些吸烟者个性化治疗； 2）以前干预措施尚未试图通过提供行为加强的禁欲影响救济预防消息； 3）目前对VHA健康差异的了解很少艾滋病毒退伍军人中戒烟药物治疗的处方。

项目成果

期刊论文数量（12）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Sexual orientation, attraction and risk for deliberate self-harm: Findings from a nationally representative sample.

DOI：
10.1016/j.psychres.2020.112863
发表时间：
2020-02-10
期刊：
Psychiatry research
影响因子：
11.3
作者：
Mann AJ;Patel TA;Elbogen EB;Calhoun PS;Kimbrel NA;Wilson SM
通讯作者：
Wilson SM

Barriers to the use of Veterans Affairs health care services among female veterans who served in Iraq and Afghanistan.

在伊拉克和阿富汗服役的女性退伍军人使用退伍军人事务部医疗保健服务的障碍。

DOI：
10.1037/ser0000230
发表时间：
2019
期刊：
Psychological services
影响因子：
2.3
作者：
Newins,AmieR;Wilson,SarahM;Hopkins,TiffanyA;Straits-Troster,Kristy;Kudler,Harold;Calhoun,PatrickS
通讯作者：
Calhoun,PatrickS

Predictors of prenatal smoking among US women veterans.

美国女退伍军人产前吸烟的预测因素。

DOI：
10.1177/1359105320913100
发表时间：
2021
期刊：
Journal of health psychology
影响因子：
3.2
作者：
Coleman,JessicaN;DeRycke,EricC;Bastian,LoriA;Calhoun,PatrickS;Beckham,JeanC;Kroll-Desrosiers,AimeeR;Haskell,SallyG;Mattocks,Kristin;Brandt,CynthiaA;Wilson,SarahM
通讯作者：
Wilson,SarahM

Systematic Decision-Making for Using Technological Strategies to Implement Evidence-Based Interventions: An Illustrated Case Study.