Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, OH.
Division of Biostatistics, College of Public Health, Ohio State University, Columbus, OH.
Nicotine Tob Res. 2017 Nov 7;19(12):1499-1507. doi: 10.1093/ntr/ntw265.
Community health workers (CHW) may be effective in the delivery of tobacco dependence treatment with underserved groups. This study evaluated two evidence-based CHW models of treatment. It was hypothesized that smokers assigned to a CHW face-to-face condition would have higher abstinence at 12-month posttreatment than smokers enrolled in CHW referral to a state-sponsored quitline condition. Intrapersonal and treatment-related factors associated with abstinence at 12 months were determined.
A group-randomized trial was conducted with residents of 12 Ohio Appalachian counties with counties (n = 6) randomized to either a CHW face-to-face (F2F) or CHW quitline (QL) condition. Both conditions included behavioral counseling and free nicotine replacement therapy for 8 weeks. Follow-up data were collected at 3-, 6-, and 12-month posttreatment. Biochemically validated abstinence at 12 months served as the primary outcome.
Seven hundred and seven participants were enrolled (n = 353 CHWF2F; n = 354 CHWQL). Baseline sample characteristics did not differ by condition. Using an intent-to-treat analysis (85.4% retention at 12 months), 13.3% of CHWF2F participants were abstinent at 12 months, compared to 10.7% of CHWQL members (OR = 1.28; 95% confidence interval [CI] = 0.810, 2.014; p = .292). No differences in abstinence were noted at 3 or 6 months by condition. Age, marital status, and baseline levels of cigarette consumption, depressive symptoms, and self-efficacy for quitting in positive settings were associated with abstinence, as was counseling dose during treatment.
This research adds to the body of science evaluating the effectiveness of CHW models of tobacco dependence treatment. Both approaches may offer promise in low-resource settings and underserved regions.
This 12-county community-based group-randomized trial in Ohio Appalachia adds to the body of science evaluating the effectiveness of CHW models of tobacco dependence treatment. Both CHW approaches may offer promise in low-resource settings and underserved regions. These findings are useful to national, state, and local tobacco control agencies, as they expand delivery of preventive health care services postadoption of the Affordable Care Act in the United States.
社区卫生工作者（CHW）可能在为服务不足的群体提供烟草依赖治疗方面具有一定效果。本研究评估了两种基于循证的 CHW 治疗模式。假设与参加 CHW 转介至州立戒烟热线的吸烟者相比，分配给 CHW 面对面治疗的吸烟者在治疗后 12 个月时的戒烟率更高。确定了与 12 个月时戒烟相关的个体内和治疗相关因素。
在俄亥俄州阿巴拉契亚地区的 12 个县开展了一项群组随机试验，各县（n = 6）随机分为 CHW 面对面（F2F）或 CHW 戒烟热线（QL）组。两种条件都包括行为咨询和 8 周的免费尼古丁替代疗法。在治疗后 3、6 和 12 个月收集随访数据。以治疗后 12 个月的生物化学验证的戒烟作为主要结局。
共招募了 707 名参与者（n = 353 CHWF2F；n = 354 CHWQL）。基线样本特征在条件间无差异。采用意向治疗分析（12 个月时 85.4%的保留率），CHWF2F 组参与者在 12 个月时的戒烟率为 13.3%，而 CHWQL 组为 10.7%（OR = 1.28；95%置信区间[CI] = 0.810，2.014；p =.292）。在治疗后 3 或 6 个月时，两组间的戒烟率无差异。年龄、婚姻状况以及基线时的吸烟量、抑郁症状和积极环境下戒烟的自我效能感，以及治疗期间的咨询剂量均与戒烟相关。
这项研究增加了评估社区卫生工作者模式在烟草依赖治疗中的有效性的科学依据。这两种方法在资源匮乏的环境和服务不足的地区都可能有一定前景。
这项在俄亥俄州阿巴拉契亚地区的 12 县社区为基础的群组随机试验增加了评估社区卫生工作者模式在烟草依赖治疗中的有效性的科学依据。这两种 CHW 方法在资源匮乏的环境和服务不足的地区都可能有一定前景。这些发现对于美国在通过《平价医疗法案》后扩大预防保健服务的提供时，对国家、州和地方的烟草控制机构都具有重要意义。
