A Stepped Care Approach to Treating Tobacco Use in Rural Veterans

Обзор

Tobacco use remains prevalent among Veterans. Although effective smoking cessation interventions exist, long-term term quit rates remain sub-optimal. The project will investigate the feasibility of a stepped care approach to treating tobacco use that includes enhancements based on initial response to treatment to augment the investigators' existing tailored tobacco treatment intervention.

Подробное описание

Rural tobacco users (cigarette smokers, smokeless tobacco users, and users of other forms of tobacco) from the Iowa City VA Health Care System will be proactively recruited using information obtained from the electronic medical record. All participants will receive the investigators' tailored, six session smoking cessation intervention developed over a series of projects funded by ORH. This includes a counseling protocol tailored to tobacco users' individual needs and associated risk factors as well as pharmacotherapy selected using shared decision making. Participants who are unable to quit initially will be provided with enhanced counseling based on self-monitoring and scheduled reduced smoking. Those who are able to quit using tobacco during the initial treatment phase will be given an extended, four-session counseling protocol that incorporates new content based on established interventions from positive psychology in an effort to reduce relapse.

Вмешательства

• Поведенческое Tailored behavioral counseling
  Participants will initially receive a six-session telephone intervention. Standard cognitive behavioral treatment strategies will be included. Participants will be screened for elevated depressive symptoms, risky alcohol use, and concerns about weight and and offered supplemental behavioral counseling related to these issues as appropriate. Those that are unable to quit tobacco initially will receive an enhanced, four-session counseling module focused on reduced scheduled smoking. Those who do q
• Препарат Tobacco cessation pharmacotherapy
  Pharmacotherapy will be selected based on medical and psychiatric history and potential interactions with other current medications combined with shared decision making. Options will include nicotine gum (2 and 4 mg), nicotine lozenge (2 and 4 mg), nicotine patch (7, 14, and 21 mg), bupropion (150 mg twice daily) and varenicline (1 mg twice daily). Monotherapy and combination therapy options will be provided.

Первичные конечные точки

• Tobacco cessation [Срок оценки: 6 months]

Вторичные конечные точки (2)

• Tobacco cessation [Срок оценки: 3 months]
• Salivary cotinine levels (in ng/ml) [Срок оценки: 6 months]

Критерии участия

Критерии включения

• Use tobacco (cigarettes, smokeless tobacco, pipes, cigars, hookah) on a daily basis
• Be willing to make a quit attempt in the next 30 days
• Able to provide informed consent
• Have access to a telephone
• Have a stable residence,

Критерии исключения

• Planning to move within the next 6 months
• Terminal illness
• Unstable psychiatric disorder (e.g., acute psychosis)

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Распределение

Не применимо

Модель

Одна группа

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

США · 1 центр

• Iowa City VA Healthcare System — Iowa City

Идентификаторы

NCT: NCT04501016 · IowacityVAMC

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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