Accelerating Health Equity via Just-In-Time Adaptive Interventions (JITAIs):Scalable and High Impact mHealth Precision Smoking Relapse Prevention

通过及时适应性干预措施 (JITAI) 加速健康公平：可扩展且高影响力的移动医疗精准预防吸烟复吸

• 批准号: 10494168
• 负责人: Bryan W. Heckman
• 金额: $ 62.89万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10494168
• 关键词: Chronic Disease; Time; adaptive intervention; disease disparity; disorder later incidence prevention; health equity; innovation; mHealth; smoking relapse

PROJECT SUMMARY/ABSTRACT Tobacco smoking serves as a primary preventable transdiagnostic risk factor that, if targeted more effectively, could reduce a wide range of health disparities in prevalence, severity, treatment efficacy, and mortality across many chronic health conditions (e.g., diabetes, obstructive sleep apnea), reduce complexity/multimorbidity, and reduce healthcare costs by up to 80%. The Southeast, in particular, has an urgent need to disrupt the status quo of tobacco control (<2% CDC recommend appropriations; highest smoking and mortality) driven in large part through neglected patterns of SDoH (poverty, access to care) that disproportionately impact racial and ethnic minorities in the form of greater smoking and chronic diseases, and ultimately nearly a decade of life lost. Unfortunately, only 5% of smoking cessation attempts last at least one year, with lower success among Black smokers even though they smoke at similar rates and intensity, and make more quit attempts. Mobile health (mHealth) may have particular utility in addressing racial disparities. Blacks smokers show high engagement rates with smartphones to access healthcare and greater adherence to digital interventions, which may facilitate tailoring to meet distinct needs. There is an urgent need to overcome equity gaps, which will require diversity and inclusion of individuals from representative races/ethnicities to identify effective treatments. There is a need for just-in-time adaptive interventions (JITAIs) that 1) can be deployed rapidly (ideally before craving occurs), 2) effectively prevent or attenuate cravings quickly, and 3) are amenable to personalized treatment. Our automated, yet personalized, JITAI app, QuitBuddy, allows patients to prepare for high-risk situations before they arise, effectively promoting abstinence and preventing relapse. Our overall goals are to optimize smart algorithms, identify personalized relapse risk, and automatically prompt delivery a real-time, preemptive manner, upon approaching personalized high-risk locations. Results from a NIDA-funded (K23) pilot randomized controlled trial demonstrated outstanding usability (top 10% of over 500 apps), acceptability (>80% compliance), and technical feasibility (<10% GPS data). We build upon these promising data by testing effectiveness in fully powered and rigorous SMART design, with diverse representation of underserved populations, and meeting community needs for SDoH interventions. Aims 1&2: Evaluate QuitBuddy and SDoH augmentation intervention effectiveness for smoking cessation and relapse prevention via pragmatic remote SMART design (N=2,090). We expect superior 6-month biochemically verified abstinence rates for QuitBuddy and SDoH augmentation interventions, relative to controls. Exploratory Aims: Test potential moderators/mediators. Our approach integrates for the first time established theories of relapse risk, evidence-based treatment, smartphone/GPS technology, and SDoH. As such, this project offers high-impact solutions to address health disparities across a wide range of chronic diseases that disproportionately affect underserved populations.

项目摘要/摘要 烟草吸烟是主要可预防的转诊危险因素 可以降低整个患病率，严重性，治疗效率和死亡率的广泛健康差异 许多慢性健康状况（例如，糖尿病，阻塞性睡眠呼吸呼吸暂停），降低复杂性/多种病态和 将医疗保健成本降低多达80％。尤其是东南部，迫切需要破坏现状 烟草控制（<2％CDC建议拨款；最高吸烟和死亡率）在很大程度上驱动 通过被忽视的SDOH（贫困，获得护理）的模式，对种族和种族产生不成比例的影响 少数群体以更大的吸烟和慢性疾病的形式，最终将近十年的生活丧失了。 不幸的是，只有5％的吸烟尝试持续至少一年，黑色的成功较低 即使吸烟者以相似的速度和强度吸烟，并进行了更多的尝试。移动健康 （MHealth）可能在解决种族差异方面具有特殊的效用。黑人吸烟者表现出很高的参与度 使用智能手机获得医疗保健和更大的数字干预措施的比率，这可能有助于 裁缝以满足不同的需求。迫切需要克服股权差距，这将需要多样性 并包括来自代表性种族/种族的个人，以识别有效的治疗方法。有需要 对于及时的自适应干预措施（JITAI），可以迅速部署（理想情况下渴望发生）， 2）有效防止或快速减轻渴望，3）适合个性化治疗。我们的 自动化但个性化的Jitai应用程序，Quitbuddy，允许患者为高风险情况做准备 它们出现，有效地促进禁欲并防止复发。我们的总体目标是优化智能 算法，确定个性化的复发风险，并自动提示实时，先发制人 态度，接近个性化的高风险位置。 NIDA资助的（K23）飞行员的结果随机 对照试验显示出未出色的可用性（占500多个应用程序的10％），可接受性（> 80％的合规性）， 和技术可行性（<10％GPS数据）。我们通过测试充分的效力来建立这些有希望的数据 有能力且严格的智能设计，具有服务不足的人群的不同代表，会议 SDOH干预措施的社区需求。目标1和2：评估戒烟和SDOH增强干预 通过务实的远程智能设计（n = 2,090），戒烟和预防复发的有效性。我们 期望较高的6个月生物化学验证的戒烟率和SDOH增强率 干预措施，相对于控件。探索目的：测试潜在的主持人/调解人。我们的方法 首次集成了复发风险，循证治疗，智能手机/GPS的理论 技术和SDOH。因此，该项目提供了高影响力的解决方案，以解决跨A的健康差异 多种慢性疾病范围不成比例地影响服务不足的人群。