Forced Smoking Abstinence Not Enough for Smoking Cessation
Forced Smoking Abstinence Not Enough for Smoking Cessation
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DOI：
10.1001/jamainternmed.2013.197
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发表时间：
2013-05-13
影响因子：
39
通讯作者：
Bock, Beth
中科院分区：
文献类型：
--
作者：
Clarke, Jennifer G.;Stein, L. A. R.;Bock, Beth
重要性：数以百万计的美国人在进入无烟监狱和监狱时被迫戒烟，但大多数人在释放后几天内又重新吸烟。需要采取干预措施，在出狱后维持烟草戒断。目的：评估基于动机访谈（MI）和认知行为疗法（CBT）的WISE干预（Inside for Smoking Elimination）在减少从无烟监狱释放后再次吸烟的程度。设计：参与者在从无烟监狱释放前约8周被招募，并随机分为6周的教育视频（对照组）或WISE干预。故事背景：美国一所无烟监狱。参与者：262名囚犯（35%为女性）。主要结局指标：持续戒烟定义为通过尿可替宁测量验证的7天点流行戒烟。结果：在3周的随访中，25%的WISE干预组参与者（122人中的31人）和7%的对照组参与者（125人中的9人）继续戒烟（优势比[OR]， 4.4; 95% CI, 2.0-9.7）。除了干预外，西班牙裔、计划戒酒、监禁超过6个月都与保持戒酒的可能性增加有关。在logistic回归分析中，随机分配到WISE干预组的参与者在3周随访时保持戒烟的可能性是随机分配到对照组的参与者的6.6倍（95% CI, 2.5-17.0）。在为期3周的随访中，非吸烟者在释放后3个月进行了额外的随访，通过尿可替宁测量（OR, 5.3; 95% CI, 1.4-23.8）证实，WISE干预中12%的参与者（122人中的14人）和2%的对照组参与者（125人中的3人）在3个月时不吸烟。结论与意义：监禁期间单独强制戒烟对释放后吸烟状况影响不大。在释放前提供的行为干预大大改善了社区中可替宁证实的戒烟。
Importance: Millions of Americans are forced to quit smoking as they enter tobacco-free prisons and jails, but most return to smoking within days of release. Interventions are needed to sustain tobacco abstinence after release from incarceration.Objective: To evaluate the extent to which the WISE intervention (Working Inside for Smoking Elimination), based on motivational interviewing (MI) and cognitive behavioral therapy (CBT), decreases relapse to smoking after release from a smoke-free prison.Design: Participants were recruited approximately 8 weeks prior to their release from a smoke-free prison and randomized to 6 weekly sessions of either education videos (control) or the WISE intervention.Setting: A tobacco-free prison in the United States.Participants: A total of 262 inmates (35% female).Main Outcome Measure: Continued smoking abstinence was defined as 7-day point-prevalence abstinence validated by urine cotinine measurement.Results: At the 3-week follow-up, 25% of participants in the WISE intervention (31 of 122) and 7% of the control participants (9 of 125) continued to be tobacco abstinent (odds ratio [OR], 4.4; 95% CI, 2.0-9.7). In addition to the intervention, Hispanic ethnicity, a plan to remain abstinent, and being incarcerated for more than 6 months were all associated with increased likelihood of remaining abstinent. In the logistic regression analysis, participants randomized to the WISE intervention were 6.6 times more likely to remain tobacco abstinent at the 3-week follow up than those randomized to the control condition (95% CI, 2.5-17.0). Nonsmokers at the 3-week follow-up had an additional follow-up 3 months after release, and overall 12% of the participants in the WISE intervention (14 of 122) and 2% of the control participants (3 of 125) were tobacco free at 3 months, as confirmed by urine cotinine measurement (OR, 5.3; 95% CI, 1.4-23.8).Conclusions and Relevance: Forced tobacco abstinence alone during incarceration has little impact on postrelease smoking status. A behavioral intervention provided prior to release greatly improves cotinine-confirmed smoking cessation in the community.