Randomized Trial of a Smoking Cessation Program for Persons with SMI

SMI 患者戒烟计划的随机试验

• 批准号: 7786750
• 负责人: LISA B. DIXON
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-10-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7786750
• 关键词: Abstinence; Address; Aftercare; American Lung Association; Attention; Behavior Therapy; Behavioral; Biological; Bupropion; Carbon Monoxide; Categories; Cessation of life; Characteristics; Cigarette; Clinic; Clinical Practice Guideline; Cocaine; Cognitive; Communities; Department of Defense; Diabetes Mellitus; Diagnostic; Disabled Persons; Disease; Drug usage; Education; Effectiveness; Ensure; Face; Funding; General Population; Goals; Grant; Guidelines; Health; Health Care Costs; Health care facility; Healthcare; Healthcare Systems; Heart Diseases; Heroin; Impairment; Intervention; Life; Malignant neoplasm of lung; Maryland; Measures; Medical Economics; Mental Health; Mental disorders; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Nicotine Dependence; Obesity; Outcome; Participant; Patient Self-Report; Patients; Persons; Pharmacotherapy; Phase; Policies; Population; Procedures; Public Health; Randomized; Randomized Clinical Trials; Readiness; Recruitment Activity; Reporting; Research; Schizophrenia; Series; Severities; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Social support; Specific qualifier value; Substance Addiction; Substance Use Disorder; Substance abuse problem; Technology; Testing; Tobacco use; United States; United States Agency for Healthcare Research and Quality; Veterans; Withholding Treatment; Work; abstracting; addiction; base; cigarette smoking; contingency management; cost; design; evidence base; follow-up; handicapping condition; health care quality; improved; innovation; meetings; mortality; nicotine replacement; novel strategies; outreach; programs; psychologic; public health relevance; randomized trial; smoking cessation; social; social model; substance abuser; therapy development; tool; treatment program; trial comparing

DESCRIPTION (provided by applicant): Abstract Over 70% of people with serious and persistent mental illnesses (SPMI) smoke cigarettes. We have found that delivery of the 5 As of smoking cessation (Ask, Advise, Assess, Assist, Arrange) to persons with SPMI, a practice required by the VA, produces modest reductions in smoking and some increased use of smoking cessation aids, but does not increase abstinence. Existing "best practices" for smoking cessation in SPMI produce low short-term abstinence rates and almost no sustained abstinence. A new approach is needed that is designed for persons with SPMI and utilizes all available strategies for addiction treatment. We have developed an intervention called "Behavioral Treatment of Smoking Cessation in SPMI" (BTSCS), an innovative program that supplements pharmacotherapy and education with contingency management and a multifaceted behavioral group treatment that addresses the cognitive, motivational, and social support problems characteristic of people with SPMI. We propose to conduct a randomized trial of BTSCS compared to a manualized standard cessation program (StSST) that reflects current best practices. BTSCS was modeled after a successful program (Behavioral Treatment of Substance Abuse in SPMI) created by the study team that was designed for people with dual disorders. Hypotheses: We hypothesize that BTSCS will be more effective than StSST in producing and sustaining abstinence as measured by self report and expired CO levels. Subject Population: We will recruit 210 people with SPMI who smoke at least 10 cigarettes per day from the VA Maryland Healthcare System. We expect to randomize 178 people. Procedures: Participants in both conditions will receive brief outreach. Research assessments will be completed at baseline, 3 months (end of treatment), and 3- and 6- month follow ups. Potential Impact on Veterans' Health Care: The VA has recognized the high medical, economic, and social costs of smoking with directives to ensure that veterans are offered cessation programs. Testing an innovative smoking cessation treatment for persons with SPMI is highly significant for the VA because: (1) the rates of smoking among veterans are higher that the general population; (2) smoking rates among persons with SPMI are higher still, and; (3) there are virtually no smoking cessation treatments for veterans with SPMI that are effective in producing abstinence. PUBLIC HEALTH RELEVANCE: Project Narrative Despite widespread recognition of the devastating health effects of smoking and the extraordinarily high rates of smoking in people SMI, smoking in SMI has not received the full and urgent attention that it deserves. Given the elevated rates of smoking among patients with SMI, our efforts to test an innovative, broad-based smoking cessation program that is tailored to the needs of this multi-handicapped population carry significant cost, health, and quality of care implications. Integration of smoking cessation within the context of mental health treatment will also provide a new context for addressing nicotine addiction, further enhancing the public health significance of the research.

描述（由申请人提供）： 摘要超过70％的患有严重和持续性精神疾病的人（SPMI）抽烟。我们发现，戒烟（询问，建议，评估，协助，安排）的5种交付给有SPMI（VA所要求的做法）的人会减少吸烟，并增加了戒烟辅助工具的使用，但不会增加禁欲。 SPMI戒烟的现有“最佳实践”会产生低短期禁欲率，几乎没有持续的禁欲。需要一种新的方法，该方法是为SPMI的人设计的，并利用所有可用的策略进行成瘾治疗。我们已经开发了一种称为“ SPMI中戒烟的行为治疗”（BTSCS）的干预措施，该计划是一种创新的计划，该计划将药物治疗和教育补充了应急管理以及多方面的行为群体治疗，以解决人们对SPMI的认知，动机和社会支持问题的解决方案。我们建议与反映当​​前最佳实践的手动标准戒烟计划（STSST）相比，进行BTSC的随机试验。 BTSC是由研究团队创建的成功计划（SPMI中的药物滥用行为治疗）建模的，该计划是专为双重疾病的人设计的。假设：我们假设BTSC在通过自报告和过期的CO水平衡量的产生和维持戒酒方面比STSST更有效。主题人群：我们将招募210名SPMI的人，他们每天从VA Maryland Healthcare系统中吸烟至少10支香烟。我们希望将178人随机分配。程序：两种情况下的参与者都将获得简短的外展。研究评估将在基线，3个月（治疗结束）以及3个月和6个月的随访中完成。对退伍军人的医疗保健的潜在影响：弗吉尼亚州已经认识到使用指令吸烟的高医疗，经济和社会成本，以确保提供退伍军人的戒烟计划。对于VA，对SPMI患者进行创新的戒烟治疗测试是非常重要的，因为：（1）退伍军人中吸烟的速度比一般人群高； （2）SPMI患者的吸烟率更高，并且； （3）几乎没有对SPMI的退伍军人有效产生禁欲的戒烟治疗方法。 公共卫生相关性： 项目叙事尽管广泛认识到吸烟的毁灭性健康影响以及SMI的吸烟率极高，但SMI的吸烟尚未得到应有的全部和紧急关注。鉴于SMI患者的吸烟率升高，我们为测试创新的，基于广泛的吸烟计划的努力量身定制，该计划是根据此多障碍人群的需求量身定制的，具有巨大的成本，健康和护理质量的影响。在心理健康治疗背景下戒烟的整合还将为解决尼古丁成瘾的新背景提供新的背景，从而进一步增强了研究的公共健康意义。