提示: 手机请竖屏浏览!

电子香烟、奖励和药物戒烟的实用性试验
A Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation


Scott D. Halpern ... 其他 • 2018.06.14
相关阅读
• 肥胖悖论或许可用瘦体重解释 • 戒烟、体重变化、2型糖尿病和死亡率 • 在戒烟试验中,现金奖励的效果优于免费药物 • 电子香烟是否安全 • 吸烟和蛛网膜下腔出血:又一个不要开始吸烟的原因

如何提高戒烟成功率?世界无烟日前夕NEJM发论文指方向

 

徐志杰

浙江大学医学院

 

前几天是第31个世界无烟日。每到无烟日,必谈戒烟。

查看更多

摘要


背景

经济奖励、药物疗法和电子香烟能否促进未经选择的吸烟者戒烟尚不清楚。

 

方法

我们将54家公司雇员中的吸烟者随机分组,接受4种戒烟干预措施中的1种或常规治疗(usual care)。常规治疗包括提供有关戒烟益处的信息以及发送激励短信。4种干预措施包括常规治疗加以下措施中的1种:免费戒烟辅助药物(尼古丁替代疗法或药物疗法,如果标准疗法失败,则提供电子香烟);免费电子香烟,不要求已经尝试过标准疗法;免费戒烟辅助药物加600美元的持续戒烟奖励;或免费戒烟辅助药物加存入每名参与者独立账户中的600美元可取出资金,如果未达到戒烟阶段目标,将从账户中扣钱。主要结局为目标戒烟开始日期后持续戒烟6个月。

 

结果

在受邀参与试验的6,131名吸烟者中,125名拒绝参与,6,006名被随机分组。在常规治疗组、免费戒烟辅助药物组、免费电子香烟组、奖励组和可取出存款组中,截至6个月时的持续戒烟率分别为0.1%、0.5%、1.0%、2.0%和2.9%。在持续戒烟率方面,可取出存款和奖励的效果优于免费戒烟辅助药物(分别P<0.001和P=0.006,多重比较校正后的显著性水平)。可取出存款的效果优于免费电子香烟(P=0.008)。免费电子香烟的效果不优于常规治疗(P=0.20),也不优于免费戒烟辅助药物(P=0.43)。在1,191名积极投入试验(“积极投入”队列)的雇员(19.8%)中,持续戒烟率为未积极投入试验的参与者的4~6倍,相对疗效相似。

 

结论

在这项关于戒烟的实用性试验中,与单独提供免费戒烟辅助药物相比,免费戒烟辅助药物加经济奖励获得了较高的持续戒烟率。在接受常规治疗(信息和激励短信)的吸烟者中,加用免费戒烟药物或电子香烟未产生获益(由Vitality Institute资助;在ClinicalTrials.gov注册号为NCT02328794)。





作者信息

Scott D. Halpern, M.D., Ph.D., Michael O. Harhay, Ph.D., Kathryn Saulsgiver, Ph.D., Christine Brophy, Andrea B. Troxel, Sc.D., and Kevin G. Volpp, M.D., Ph.D.
From the Departments of Medicine (S.D.H., K.G.V.), Medical Ethics and Health Policy (S.D.H., K.G.V.), and Biostatistics, Epidemiology, and Informatics (S.D.H., M.O.H., K.S.), University of Pennsylvania Perelman School of Medicine, the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics (S.D.H., M.O.H., K.S., A.B.T., K.G.V.), the Palliative and Advanced Illness Research Center (S.D.H., M.O.H.), and the Department of Health Care Management, Wharton School (K.G.V.), University of Pennsylvania, and the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center (M.O.H., K.G.V.) — all in Philadelphia; and the Vitality Institute (C.B.) and the Division of Biostatistics, New York University Langone Medical Center (A.B.T.) — both in New York. Address reprint requests to Dr. Halpern at the University of Pennsylvania Perelman School of Medicine, 301 Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104–6021, or at shalpern@upenn.edu.

 

参考文献

1. Willis Towers Watson. Full report: 2016 21st annual Willis Towers Watson Best Practices in Health Care Employer Survey — high-performance insights. January 4, 2017 (https://www.willistowerswatson.com/en/insights/2017/01/full-report-2016-21st-annual-willis-towers-watson-best-practices-in-health-care-employer-survey).

2. Rostron BL, Chang CM, Pechacek TF. Estimation of cigarette smoking-attributable morbidity in the United States. JAMA Intern Med 2014;174:1922-1928.

3. Danaei G, Ding EL, Mozaffarian D, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009;6(4):e1000058-e1000058.

4. Berman M, Crane R, Seiber E, Munur M. Estimating the cost of a smoking employee. Tob Control 2014;23:428-433.

5. Volpp KG, Troxel AB, Pauly MV, et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med 2009;360:699-709.

6. Halpern SD, French B, Small DS, et al. Randomized trial of four financial-incentive programs for smoking cessation. N Engl J Med 2015;372:2108-2117.

7. Kahneman D, Tversky A. Prospect theory: an analysis of decision under risk. Econometrica 1979;47:263-291.

8. Halpern SD, Asch DA, Volpp KG. Commitment contracts as a way to health. BMJ 2012;344:e522-e522.

9. Loudon K, Treweek S, Sullivan F, Donnan P, Thorpe KE, Zwarenstein M. The PRECIS-2 tool: designing trials that are fit for purpose. BMJ 2015;350:h2147-h2147.

10. Kullgren JT, Troxel AB, Loewenstein G, et al. Individual- versus group-based financial incentives for weight loss: a randomized, controlled trial. Ann Intern Med 2013;158:505-514.

11. Asch DA, Troxel AB, Stewart WF, et al. Effect of financial incentives to physicians, patients, or both on lipid levels: a randomized clinical trial. JAMA 2015;314:1926-1935.

12. Hughes JR, Keely JP, Niaura RS, Ossip-Klein DJ, Richmond RL, Swan GE. Measures of abstinence in clinical trials: issues and recommendations. Nicotine Tob Res 2003;5:13-25.

13. West R, Hajek P, Stead L, Stapleton J. Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction 2005;100:299-303.

14. SRNT Subcommittee on Biochemical Verification. Biochemical verification of tobacco use and cessation. Nicotine Tob Res 2002;4:149-159.

15. Jacob P III, Hatsukami D, Severson H, Hall S, Yu L, Benowitz NL. Anabasine and anatabine as biomarkers for tobacco use during nicotine replacement therapy. Cancer Epidemiol Biomarkers Prev 2002;11:1668-1673.

16. Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V. Evaluating nicotine levels selection and patterns of electronic cigarette use in a group of “vapers” who had achieved complete substitution of smoking. Subst Abuse 2013;7:139-146.

17. van Staden SR, Groenewald M, Engelbrecht R, Becker PJ, Hazelhurst LT. Carboxyhaemoglobin levels, health and lifestyle perceptions in smokers converting from tobacco cigarettes to electronic cigarettes. S Afr Med J 2013;103:865-868.

18. Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat 1979;6:65-70.

19. Cahill K, Hartmann-Boyce J, Perera R. Incentives for smoking cessation. Cochrane Database Syst Rev 2015;5:CD004307-CD004307.

20. Asay GRB, Homa DM, Abramsohn EM, Xu X, O’Connor EL, Wang G. Reducing smoking in the US federal workforce: 5-year health and economic impacts from improved cardiovascular disease outcomes. Public Health Rep 2017;132:646-653.

21. Schult TM, Kelly Q, Schmunk SK, Awosika ER. From policy to practice: tobacco use cessation for employees in the Veterans Health Administration. J Occup Environ Med 2016;58:525-531.

22. Huang H, Mattke S, Batorsky B, Miles J, Liu H, Taylor E. Incentives, program configuration, and employee uptake of workplace wellness programs. J Occup Environ Med 2016;58:30-34.

23. Fairchild AL, Sung Lee J, Bayer R, Curran J. E-cigarettes and the harm-reduction continuum. N Engl J Med 2018;378:216-219.

24. National Academies of Sciences, Engineering, and Medicine. Public health consequences of e-cigarettes. Washington, DC: National Academies Press, 2018.

25. Halpern SD, French B, Small DS, et al. Heterogeneity in the effects of reward- and deposit-based financial incentives on smoking cessation. Am J Respir Crit Care Med 2016;194:981-988.

26. Bullen C, Howe C, Laugesen M, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet 2013;382:1629-1637.

27. Caponnetto P, Campagna D, Cibella F, et al. EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One 2013;8(6):e66317-e66317.

服务条款 | 隐私政策 | 联系我们