Improving the Reach and Effectiveness of Smoking Cessation Services Targeted to Veterans Living with HIV

提高针对感染艾滋病毒的退伍军人的戒烟服务的覆盖面和有效性

• 批准号: 10020915
• 负责人: SHERYL L CATZ
• 金额: $ 69.56万
• 依托单位: SEATTLE INST FOR BIOMEDICAL/CLINICAL RES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-19 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10020915
• 关键词: Abstinence; Address; Adherence; Aging; Alcohol or Other Drugs use; Awareness; Behavior; Behavioral; Biochemical; CD4 Lymphocyte Count; Car Phone; Caring; Cause of Death; Characteristics; Cigarette; Clinic; Clinical; Clinical Data; Cognitive; Cohort Studies; Communicable Diseases; Community Healthcare; Counseling; Data; Depressed mood; Effectiveness; Enrollment; Exercise; General Population; Geography; Goals; HIV; Health; Health Personnel; Health behavior; Hour; Immunologic Markers; Immunologics; Individual; Infection; Intervention; Knowledge; Malignant Neoplasms; Medical; Modeling; Moods; Motivation; Nicotine Dependence; Outcome; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacotherapy; Pharmacy facility; Practice Guidelines; Prevalence; Process; Provider; Public Health; Randomized; Randomized Controlled Trials; Readiness; Request for Applications; Research; Research Infrastructure; Research Personnel; Risk; Sampling; Self Efficacy; Series; Services; Site; Smoke; Smoker; Smoking; Smoking History; Societies; Stress; Telephone; Testing; Text; Text Messaging; Time; Tobacco Use Cessation; Tobacco use; Veterans; Viral; Voice; Wellness Program; Work; antiretroviral therapy; arm; base; care systems; co-infection; comorbid depression; comorbidity; compare effectiveness; data resource; design; evidence base; experience; follow-up; health care delivery; health disparity; health goals; immunological status; improved; indexing; innovation; interest; medication compliance; mortality; mortality risk; motivational enhancement therapy; motivational intervention; nicotine replacement; nicotine use; non-smoker; nutrition; primary outcome; programs; quitline; recruit; response; secondary outcome; skills; smoking abstinence; smoking cessation; smoking prevalence; standard care; stress management; theories; therapy design; treatment adherence; treatment comparison

PROJECT SUMMARY Tobacco use remains the leading preventable cause of death and illness in our society, and smoking rates are disproportionately high among people living with HIV. NCI, nicotine dependence researchers, and HIV clinicians have all called for research to evaluate targeted and tailored smoking cessation programs for smokers living with HIV (SLWH), leading to the current request for applications (RFA-CA-18-027). Research suggests SLWH are largely unaware of the HIV-specific deleterious effects of smoking and often lack motivation and confidence in their ability to quit. For these reasons, we developed the Wellness Intervention for Smokers with HIV (WISH). WISH is grounded in the Information-Motivation-Behavioral Skills (IMB) Model and delivered remotely by mobile phone (voice and text message). The program is designed for all SLWH, regardless of their initial motivation to quit. WISH follows evidence-based, best practice guidelines for nicotine dependence treatment, but is innovative in its use of a more comprehensive wellness approach. That is, the intervention addresses both smoking and a number of other personally relevant health behaviors (such as treatment adherence, stress/mood, nutrition, other substance use, etc.), making it relevant and engaging to all SLWH, not just those ready to stop smoking. For those not yet ready to quit, WISH is designed to build and strengthen motivation and self-efficacy for quitting, while smokers also work on other personal health goals. Once ready to quit smoking, participants receive evidence-based cognitive-behavioral counseling and encouragement to use nicotine replacement therapy (NRT) or other appropriate pharmacotherapy. WISH builds on our extensive experience creating motivationally-enhanced cessation interventions and has been pilot tested with SLWH. In this trial, we will compare the effectiveness of WISH to standard care services offered through the National VA Quitline and the SmokefreeVET texting program, NCI-supported tobacco cessation services available to all Veterans. Participants in both arms can receive phone/ text counseling and have access to pharmacotherapy through VA. Primary outcomes will be biochemically confirmed 7-day point prevalence smoking abstinence and presence of any 24-hour intentional quit attempts. Secondary outcomes will include prolonged abstinence, change in cigarettes per day, intermediate change process outcomes based on the IMB model, as well as metrics of intervention reach and implementation. Consistent with RFA goals, we will also describe comorbidities and explore intervention impact on markers of immune status and mortality risk using the outstanding clinical data resources available through the Veterans Aging Cohort Study (VACS). If effective, WISH could meaningfully reduce smoking among HIV+ Veterans nationwide. To support this goal, dissemination efforts are planned in Year 5 to share the WISH program with the National VA Quitline. Because VA is the largest U.S. provider of HIV care, this research has the potential for significant public health impact.

项目摘要 烟草的使用仍然是我们社会中可预防的死亡和疾病的主要理由，并吸烟 在艾滋病毒患者中，率不成比例。 NCI，尼古丁依赖研究人员，以及 艾滋病毒临床医生都呼吁进行研究，以评估针对性和量身定制的戒烟计划 患有艾滋病毒（SLWH）的吸烟者，导致当前的申请请求（RFA-CA-18-027）。研究 建议SLWH在很大程度上没有意识到吸烟的艾滋病毒特异性有害影响 动机和对他们退出能力的信心。由于这些原因，我们开发了健康的干预措施 艾滋病毒的吸烟者（希望）。愿望是基于信息动机行为技能（IMB）模型的基础 通过手机（语音和短信）远程交付。该程序是为所有SLWH设计的 不管他们最初的戒烟动机。愿望遵循基于证据的尼古丁的最佳实践指南 依赖治疗，但在使用更全面的健康方法方面具有创新性。也就是说， 干预措施涉及吸烟和许多其他个人相关的健康行为（例如 治疗依从性，压力/情绪，营养，其他物质使用等），使其与所有人相关且参与 SLWH，不仅是那些准备停止吸烟的人。对于尚未准备退出的人，愿望旨在建立和 增强戒烟的动力和自我效能感，而吸烟者还致力于其他个人健康目标。 准备戒烟后，参与者将获得基于证据的认知行为咨询和 鼓励使用尼古丁替代疗法（NRT）或其他适当的药物治疗。希望 建立我们的丰富经验，创造动力增强的戒烟干预措施，一直 飞行员用SLWH测试。在此试验中，我们将比较愿望对标准护理服务的有效性 通过国家VA Quitline和SmokeFreevet发短信计划提供的NCI支持的烟草 所有退伍军人都可以使用戒烟服务。双臂参加的参与者可以接收电话/文字咨询，并且 可以通过VA获得药物疗法。主要结果将是生化确认的7天点 戒烟的普遍性和任何24小时故意退出尝试的存在。次要结果 将包括节制长期，每天的香烟变化，基于中间变化过程 在IMB模型以及干预范围的指标上。与RFA目标一致，我们 还将描述合并症并探索干预对免疫状况和死亡率风险标记的影响 使用通过退伍军人老化队列研究（VACS）获得的出色临床数据资源。如果 有效，愿望可以有意义地减少全国艾滋病毒+退伍军人的吸烟。为了支持这个目标， 计划在5年级进行传播工作，以与国家弗吉尼亚州Quitline分享愿望计划。因为 弗吉尼亚州是美国最大的艾滋病毒护理提供商，这项研究有可能产生重大公共卫生影响。