Effectiveness of Proactive Tobacco Treatment in Diverse Low Income Smokers

主动烟草治疗对不同低收入吸烟者的有效性

• 批准号: 8699155
• 负责人: STEVEN FU
• 金额: $ 17.02万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-23 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8699155
• 关键词: Abstinence; Adult; Affect; Age-Years; American; Behavioral; Caring; Cigarette; Clinical; Clinical Trials; Collaborations; Combination Drug Therapy; Counseling; Coupled; Data; Data Analyses; Disease; Economics; Effectiveness; Enrollment; Ethnic Origin; Evidence based treatment; Female; Funding; Gender; Goals; Health; Health Care Costs; Health Insurance; Health Personnel; Health Services Accessibility; Healthcare; Healthcare Systems; High Prevalence; Income; Individual; Intervention; Knowledge; Life; Low Income Population; Low income; Mails; Mediator of activation protein; Methodology; Minnesota; Minority; Morbidity - disease rate; Motivation; Outcome; Participant; Patients; Persons; Pharmacotherapy; Population; Population Heterogeneity; Poverty; Provider; Qualifying; Race; Randomized; Randomized Controlled Trials; Readiness; Research; Research Design; Sampling; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Survey Methodology; Surveys; Telephone; Testing; Time; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Treatment Efficacy; United States; Withholding Treatment; Work; administrative database; base; cost; cost effective; cost effectiveness; effective therapy; evidence base; experience; federal poverty level; follow-up; health disparity; interest; intervention effect; mortality; nicotine replacement; novel; outreach; population based; primary outcome; programs; quitline; secondary outcome; smoking cessation; stressor; theories; treatment as usual; willingness

DESCRIPTION (provided by applicant): There is a high prevalence of smoking and high burden of tobacco related disease among low income populations. Effective, evidenced-based smoking cessation treatments are available, but low-income and minority smokers are less likely than higher-income and white smokers to use these treatments, especially the most comprehensive forms that include a combination of pharmacotherapy and intensive behavioral counseling. In this application, we test a novel proactive outreach strategy, coupled with free nicotine replacement therapy (NRT) to increase the population impact of tobacco cessation treatment for diverse, low income smokers. Population impact is the product of treatment utilization (i.e., reach or exposure) and treatment efficacy (i.e., smoking abstinence rates among those who utilize treatment); therefore, the theory- driven approach will systematically offer low income smokers free and easy access to evidence-based treatment for tobacco dependence outside the traditional health care system. The intervention has two primary components: 1) proactive outreach to current smokers in the form of mailed invitation materials and telephone calls containing targeted health messages, and 2) facilitated access to free, comprehensive, evidence-based treatment for tobacco dependence in the form of NRT and intensive, telephone-based behavioral counseling. Our specific aims are to: 1) compare the effect of proactive outreach combined with free NRT and telephone counseling (PRO+NRT+TC) to usual care (UC) on population-level smoking abstinence rates among a diverse population of low income smokers, 2) compare the effect of PRO+NRT+TC to usual care UC on population-level tobacco treatment utilization rates, and 3) determine the cost-effectiveness of PRO+NRT+TC. This proposal will examine the effects of the intervention in a population-based sample (N=2500) of adult smokers enrolled in the Minnesota Health Care Programs (MHCP), a state-funded health insurance plan for low income persons. Baseline data will be obtained from MHCP administrative databases and a participant survey that will be conducted prior to randomization. Outcome data will be collected from a follow-up survey conducted 12 months after randomization and MHCP administrative data. The primary outcome is prolonged smoking abstinence (6 months) and will be assessed at the population level. All randomized individuals will be asked to complete the follow-up survey, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. The study team has unique, relevant experience with tobacco treatment studies in diverse, low income populations, proactive outreach and telephone counseling. We will work in partnership with the North American Quitline Consortium to disseminate study findings. If effective, proactive tobacco treatment would reduce tobacco- related morbidity, mortality and health care costs for low income Americans.

描述（由申请人提供）：低收入人群中吸烟率很高，烟草相关疾病的负担也很高。有效的、基于证据的戒烟治疗是可行的，但低收入和少数族裔吸烟者使用这些治疗的可能性低于高收入和白人吸烟者，尤其是包括药物治疗和强化行为咨询相结合的最全面的形式。在此应用中，我们测试了一种新颖的主动外展策略，结合免费尼古丁替代疗法（NRT），以增加戒烟治疗对不同低收入吸烟者的人群影响。人群影响是治疗利用率（即达到或暴露）和治疗效果（即接受治疗者的戒烟率）的乘积；因此，理论驱动的方法将系统地为低收入吸烟者在传统医疗保健系统之外免费、轻松地提供基于证据的烟草依赖治疗。该干预措施有两个主要组成部分：1）以邮寄邀请材料和包含有针对性的健康信息的电话的形式主动接触当前吸烟者，2）以以下形式促进免费、全面、循证的烟草依赖治疗： NRT 和基于电话的强化行为咨询。我们的具体目标是：1) 比较主动外展结合免费 NRT 和电话咨询 (PRO+NRT+TC) 与常规护理 (UC) 对不同低收入吸烟者群体中人群戒烟率的影响， 2) 比较 PRO+NRT+TC 与常规护理 UC 对人群烟草治疗利用率的影响，以及 3) 确定 PRO+NRT+TC 的成本效益。该提案将研究干预措施对参加明尼苏达州医疗保健计划 (MHCP) 的成年吸烟者的人口样本 (N=2500) 的影响，该计划是一项针对低收入人群的国家资助的健康保险计划。基线数据将从 MHCP 管理数据库和随机化之前进行的参与者调查中获得。结果数据将从随机化后 12 个月进行的后续调查和 MHCP 管理数据中收集。主要结局是长期戒烟（6 个月），并将在人群层面进行评估。所有随机个体都将被要求完成后续调查，无论他们是否参与烟草治疗。主要目标的数据分析将遵循意向治疗方法。研究团队在针对不同低收入人群的烟草治疗研究、主动外展和电话咨询方面拥有独特的相关经验。我们将与北美戒烟热线联盟合作传播研究结果。如果有效，积极主动的烟草治疗将降低低收入美国人与烟草相关的发病率、死亡率和医疗保健费用。

项目成果

Treatment barriers among younger and older socioeconomically disadvantaged smokers.

社会经济地位处于不利地位的年轻和老年吸烟者的治疗障碍。

• 发表时间: 2017-09-01
• 作者: Hammett, Patrick J;Fu, Steven S;Burgess, Diana J;Nelson, David;Clothier, Barbara;Saul, Jessie E;Nyman, John A;Widome, Rachel;Joseph, Anne M
• 通讯作者: Joseph, Anne M

Cost-effectiveness of population-level proactive tobacco cessation outreach among socio-economically disadvantaged smokers: evaluation of a randomized control trial.

社会经济弱势吸烟者人群层面主动戒烟的成本效益：随机对照试验评估。

• 发表时间: 2019-12
• 作者: Thao, Viengneesee;Nyman, John A;Nelson, David B;Joseph, Anne M;Clothier, Barbara;Hammett, Patrick J;Fu, Steven S
• 通讯作者: Fu, Steven S

Proactive tobacco treatment for low income smokers: study protocol of a randomized controlled trial.

低收入吸烟者的主动烟草治疗：随机对照试验的研究方案。

• 发表时间: 2014-04-09
• 影响因子: 4.5
• 作者: Fu, Steven S;van Ryn, Michelle;Burgess, Diana J;Nelson, David;Clothier, Barbara;Thomas, Janet L;Nyman, John A;Joseph, Anne M
• 通讯作者: Joseph, Anne M

Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: a randomised clinical trial.

主动烟草治疗为社会经济弱势吸烟者提供免费尼古丁替代疗法和电话咨询：一项随机临床试验。

• 发表时间: 2016-05
• 影响因子: 10
• 作者: Fu, Steven S;van Ryn, Michelle;Nelson, David;Burgess, Diana J;Thomas, Janet L;Saul, Jessie;Clothier, Barbara;Nyman, John A;Hammett, Patrick;Joseph, Anne M
• 通讯作者: Joseph, Anne M