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Grant Details

Grant Number: 5R01CA196304-04 Interpret this number
Primary Investigator: Calhoun, Patrick
Organization: Duke University
Project Title: Mobile Contingency Management for Smoking Cessation in Returning Us Veterans
Fiscal Year: 2018
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Abstract

DESCRIPTION (provided by applicant): Despite recent efforts to expand reach of smoking cessation treatment options beyond clinic based care, smoking cessation treatment including the use of smoking cessation aids remain greatly underutilized. If cessation programs are to have significant impact (Impact = Reach X Efficacy) on changing health behavior at the population level, there is a fundamental need to develop new and innovative strategies to increase treatment intensity, access, and participation. The use of intensive behavioral therapies, such as contingency management (CM), have demonstrated efficacy for reducing smoking in difficult-to-treat populations, but have had limited reach given the need to verify abstinence multiple times daily via clinic based monitoring. The development of a mobile health (mHealth) platform to provide CM has made the use of intensive CM approaches portable and feasible. The primary goal of the current study is to evaluate the effectiveness of a proactive tele-health intervention that combines evidenced based treatment for smoking cessation with smart- phone based, portable contingency management on smoking rates. The central hypothesis is that increasing the intensity of available tele-health smoking approaches through the addition of mobile CM will be an effective way to reduce smoking rates in Veterans returning from the Iraq/Afghanistan wars. Guided by strong preliminary data, this hypothesis will be tested in a comparative effectiveness trial with a two-group design in which 260 Veteran smokers will be randomized to receive either a "mCM" intervention which combines evidenced based cognitive-behavioral telephone counseling (TC), a tele-medicine clinic for access to nicotine replacement (NRT), and mCM administered through a smart phone or to a control condition that will provide controls for therapist, medication, time and attention effects. Specific aims are to evaluate (1) the impact of mCM on rates of abstinence from cigarettes as measured by bio-verified, self-reported prolonged abstinence at 3-month, 6-month, and 12 month post-randomization follow-up, (2) the relative cost-effectiveness of the mCM intervention in quality adjusted life years (QALY), and (3) potential treatment mediators including self-efficacy and treatment process mechanisms. The approach is innovative because it builds upon advances in mHealth technology and will be the first evaluation of smart phone based mobile CM in conjunction with other evidence- based smoking cessation treatment for OEF/OIF/OND Veterans. There is a surprising lack of research aimed at evaluating multi-component smoking cessation interventions that integrate CM with evidence-based cognitive-behavioral treatment and smoking cessation aids such as NRT. Cigarette smoking remains the most lethal substance use disorder in the United States and military veterans are at particular high risk for smoking related morbidity and mortality. The significance of identifying cost-effective approaches to decreasing tobacco use in the relatively young and at-risk cohort of returning Veterans could be tremendous as it will prevent significant morbidity and mortality.

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Publications

Knowledge Gaps around Smoking and Nicotine among U.S. Military Veterans Who Smoke and Implications for Practice.
Authors: Hicks T.A. , Thompson A.C. , Wilson S.M. , Travis E.A. , Beckham J.C. , Calhoun P.S. .
Source: Military behavioral health, 2019; 7(1), p. 40-45.
EPub date: 2018-12-29.
PMID: 31372310
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The association of alcohol consumption patterns with self-rated physical health and psychiatric distress among Afghanistan- and Iraq-era U.S. veterans.
Authors: Calhoun P.S. , Wilson S.M. , Dedert E.A. , Cunningham K.C. , Burroughs T.K. , Hicks T.A. , Beckham J.C. , Kudler H.S. , Straits-Troster K. .
Source: Psychiatry research, 2018 01; 259, p. 142-147.
EPub date: 2017-09-28.
PMID: 29045920
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Wall/Object Punching: An Important but Under-Recognized Form of Nonsuicidal Self-Injury.
Authors: Kimbrel N.A. , Thomas S.P. , Hicks T.A. , Hertzberg M.A. , Clancy C.P. , Elbogen E.B. , Meyer E.C. , DeBeer B.B. , Gross G.M. , Silvia P.J. , et al. .
Source: Suicide & life-threatening behavior, 2018 10; 48(5), p. 501-511.
EPub date: 2017-09-19.
PMID: 28925016
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Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans.
Authors: Calhoun P.S. , Wilson S.M. , Hertzberg J.S. , Kirby A.C. , McDonald S.D. , Dennis P.A. , Bastian L.A. , Dedert E.A. , VA Mid-Atlantic MIRECC Workgroup , Beckham J.C. .
Source: Journal of general internal medicine, 2017 Nov; 32(11), p. 1228-1234.
EPub date: 2017-08-14.
PMID: 28808856
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Low Income as a Multiplicative Risk Factor for Oral Pain and Dental Problems Among U.S. Veteran Smokers.
Authors: Hicks T.A. , Wilson S.M. , Thomas S.P. , Dennis P.A. , Neal J.M. , Calhoun P.S. .
Source: International journal of behavioral medicine, 2018 02; 25(1), p. 67-73.
PMID: 28527104
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Cigarette Smoking and Musculoskeletal Pain Severity Among Male and Female Afghanistan/Iraq Era Veterans.
Authors: Green K.T. , Wilson S.M. , Dennis P.A. , Runnals J.J. , Williams R.A. , Bastian L.A. , Beckham J.C. , Dedert E.A. , Kudler H.S. , Straits-Tröster K. , et al. .
Source: Pain medicine (Malden, Mass.), 2017-09-01; 18(9), p. 1795-1804.
PMID: 28340108
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A Preliminary Investigation of a Relapse Prevention Mobile Application to Maintain Smoking Abstinence Among Individuals With Posttraumatic Stress Disorder.
Authors: Hicks T.A. , Thomas S.P. , Wilson S.M. , Calhoun P.S. , Kuhn E.R. , Beckham J.C. .
Source: Journal of dual diagnosis, 2017 Jan-Mar; 13(1), p. 15-20.
EPub date: 2016-12-05.
PMID: 27918881
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Racial and Sociodemographic Disparities in Internet Access and eHealth Intervention Utilization Among Veteran Smokers.
Authors: Calhoun P.S. , Wilson S.M. , Hicks T.A. , Thomas S.P. , Dedert E.A. , Hair L.P. , Bastian L.A. , Beckham J.C. .
Source: Journal of racial and ethnic health disparities, 2016-09-15; , .
EPub date: 2016-09-15.
PMID: 27633267
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Exploring the relationship between posttraumatic stress disorder symptoms and momentary heart rate variability.
Authors: Green K.T. , Dennis P.A. , Neal L.C. , Hobkirk A.L. , Hicks T.A. , Watkins L.L. , Hayano J. , Sherwood A. , Calhoun P.S. , Beckham J.C. .
Source: Journal of psychosomatic research, 2016 Mar; 82, p. 31-34.
EPub date: 2016-01-13.
PMID: 26944396
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