Mobile contingency management for smoking cessation in returning US Veterans

回国退伍军人戒烟的移动应急管理

基本信息

批准号：
9208126
负责人：
PATRICK S. CALHOUN
金额：
$ 40.85万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-02-01 至 2019-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9208126
关键词：
Abstinence Afghanistan Alcohol abuse Attention Behavior Therapy Behavioral Bypass Carbon Monoxide Caring Cellular Phone Centers for Disease Control and Prevention (U.S.)Cessation of life Cigarette Clinic Cognitive Cognitive Therapy Counseling Data Data Analyses Development Drug usage Effectiveness Evaluation Evidence based treatment Freedom Geography Goals Guidelines Health Technology Health behavior change Healthcare Individual Inpatients Intervention Iraq Measures Mediating Mediator of activation protein Mental Depression Military Personnel Monitor Morbidity - disease rate Outpatients Participant Patient Self-Report Pharmaceutical Preparations Population Populations at Risk Positive Reinforcer Post-Traumatic Stress Disorders Process Quality-Adjusted Life Years Randomized Research Risk Sampling Secure Self Efficacy Services Smoker Smoking Smoking Cessation Intervention Smoking History Substance Use Disorder Telemedicine Telephone Testing Time Tobacco use Treatment outcome United States United States National Institutes of Health Veterans War Withholding Treatment base cigarette smoking cohort comparative effectiveness compare effectiveness contingency management cost effective cost effectiveness design disability disorder prevention drug abstinence effectiveness trial evidence base follow-up high risk incremental cost-effectiveness innovation mHealth medical specialties medication compliance mortality nicotine replacement novel strategies operation pain symptom portability prevent programs psychiatric symptom public health relevance relative cost smoking cessation smoking intervention substance misuse telehealth therapy design treatment duration treatment program voucher

项目摘要

DESCRIPTION (provided by applicant): Despite recent efforts to expand reach of smoking cessation treatment options beyond clinic based care, smoking cessation treatment including the use of smoking cessation aids remain greatly underutilized. If cessation programs are to have significant impact (Impact = Reach X Efficacy) on changing health behavior at the population level, there is a fundamental need to develop new and innovative strategies to increase treatment intensity, access, and participation. The use of intensive behavioral therapies, such as contingency management (CM), have demonstrated efficacy for reducing smoking in difficult-to-treat populations, but have had limited reach given the need to verify abstinence multiple times daily via clinic based monitoring. The development of a mobile health (mHealth) platform to provide CM has made the use of intensive CM approaches portable and feasible. The primary goal of the current study is to evaluate the effectiveness of a proactive tele-health intervention that combines evidenced based treatment for smoking cessation with smart- phone based, portable contingency management on smoking rates. The central hypothesis is that increasing the intensity of available tele-health smoking approaches through the addition of mobile CM will be an effective way to reduce smoking rates in Veterans returning from the Iraq/Afghanistan wars. Guided by strong preliminary data, this hypothesis will be tested in a comparative effectiveness trial with a two-group design in which 260 Veteran smokers will be randomized to receive either a "mCM" intervention which combines evidenced based cognitive-behavioral telephone counseling (TC), a tele-medicine clinic for access to nicotine replacement (NRT), and mCM administered through a smart phone or to a control condition that will provide controls for therapist, medication, time and attention effects. Specific aims are to evaluate (1) the impact of mCM on rates of abstinence from cigarettes as measured by bio-verified, self-reported prolonged abstinence at 3-month, 6-month, and 12 month post-randomization follow-up, (2) the relative cost-effectiveness of the mCM intervention in quality adjusted life years (QALY), and (3) potential treatment mediators including self-efficacy and treatment process mechanisms. The approach is innovative because it builds upon advances in mHealth technology and will be the first evaluation of smart phone based mobile CM in conjunction with other evidence- based smoking cessation treatment for OEF/OIF/OND Veterans. There is a surprising lack of research aimed at evaluating multi-component smoking cessation interventions that integrate CM with evidence-based cognitive-behavioral treatment and smoking cessation aids such as NRT. Cigarette smoking remains the most lethal substance use disorder in the United States and military veterans are at particular high risk for smoking related morbidity and mortality. The significance of identifying cost-effective approaches to decreasing tobacco use in the relatively young and at-risk cohort of returning Veterans could be tremendous as it will prevent significant morbidity and mortality.

描述（由申请人提供）：尽管最近努力将戒烟治疗选择的范围扩大到基于临床的护理之外，但包括使用戒烟辅助工具在内的戒烟治疗仍然大大未得到充分利用。如果戒烟计划要对改变人群的健康行为产生重大影响（影响 = 达到 X 功效），则根本需要制定新的创新策略来增加治疗强度、获取和参与。强化行为疗法的使用，例如应急管理（CM），已被证明可以有效减少难以治疗的人群中的吸烟，但由于需要通过临床监测每天多次验证戒烟情况，因此效果有限。提供 CM 的移动医疗 (mHealth) 平台的开发使得强化 CM 方法的使用变得便携且可行。当前研究的主要目标是评估主动远程医疗干预的有效性，该干预将基于证据的戒烟治疗与基于智能手机的便携式吸烟率应急管理相结合。核心假设是，通过添加移动CM来增加可用远程医疗吸烟方法的强度将是降低从伊拉克/阿富汗战争返回的退伍军人吸烟率的有效方法。在强有力的初步数据的指导下，这一假设将在一项两组设计的比较有效性试验中得到检验，其中 260 名退伍军人将被随机接受“mCM”干预，该干预结合了基于证据的认知行为电话咨询 (TC) ，一个远程医疗诊所，提供尼古丁替代品 (NRT) 和通过智能手机进行的 mCM 管理，或控制条件，为治疗师、药物、时间和注意力效果提供控制。具体目标是评估 (1) mCM 对戒烟率的影响，通过生物验证、自我报告的随机化随访后 3 个月、6 个月和 12 个月的长期戒烟来测量，（ 2) mCM 干预在质量调整生命年 (QALY) 中的相对成本效益，以及 (3) 潜在的治疗中介因素，包括自我效能和治疗过程机制。该方法具有创新性，因为它建立在移动医疗技术进步的基础上，并且将是对基于智能手机的移动 CM 与其他基于证据的 OEF/OIF/OND 退伍军人戒烟治疗的首次评估。令人惊讶的是，缺乏旨在评估将 CM 与循证认知行为治疗和 NRT 等戒烟辅助措施相结合的多成分戒烟干预措施的研究。吸烟仍然是美国最致命的物质使用障碍，退伍军人与吸烟相关的发病率和死亡率的风险特别高。确定具有成本效益的方法来减少相对年轻和高危退伍军人群体的烟草使用的意义可能是巨大的，因为它将防止显着的发病率和死亡率。