SELF DETERMINATION, SMOKING, DIET, AND HEALTH

一项临床试验将测试(1)源于自我决定理论的干预措施，与通常的护理相比，该干预措施适用于戒烟、改善饮食或两者兼而有之；(2)维持健康行为变化的过程的自我决定模型。所有参与者都是成年吸烟者，根据他们的低密度脂蛋白胆固醇是否达到NCEP推荐的目标(根据健康和风险状况的不同而有所不同)进行分层。那些在目标的人将被随机分配到自我决定干预或通常的戒烟护理中。那些没有达到目标的人将被随机分配到四种情况中的一种，这四种情况是由自我决定干预与通常的减少膳食脂肪摄入量的CRE的因子交叉造成的。因此，我们将测试自我决定理论干预对戒烟、改善饮食以及两者的效果。此外，使用结构方程模型，我们将测试自我决定模型对干预组和日常护理组中的数据的适合性。为期6个月的戒烟和改善饮食的干预包括一名行为改变顾问与参与者合作，鼓励和支持改变这两种危险行为中的一种或两种(取决于实验条件)。咨询师将采用自我决定理论原则，其中包括引出和承认患者的观点和价值观，提供选择和相关信息，提高感知能力，并将改变的压力降至最低。这项干预措施符合并建立在AHCPR戒烟指南和NCEP降低胆固醇指南的基础上，旨在将自我决定理论的立场付诸实施，以便测试其对改变这两种危害健康的行为的适用性。在6个月和18个月评估的结果包括7天的戒烟时点(通过血清可替宁验证)，通过24次饮食召回评估的大鼠卡路里百分比的减少，以及测量和计算的低密度脂蛋白胆固醇的改善。

A clinical trial will test (1) an intervention derived from self- determination theory and applied to smoking cessation, diet improvement, or both, as compared to usual care and (2) the self-determination model of the processes that underlie maintained health-behavior change. All participants will be adult cigarette smokers, stratified in terms of whether their LDL cholesterol is or is not at NCEP-recommended goal (which varies as a function of health and risk status). Those at goal will be randomly assigned either to a self-determination intervention or to usual care for smoking cessation. Those not at goal will be randomly assigned to one of four conditions created by the factorial cross of a self-determination intervention versus usual cre for reduction in dietary fat intake. Thus, we will test the effects of the self- determination-theory intervention for smoking cessation, diet improvement, and both. Further, using Structural Equation Modeling we will test the fit of the self-determination model to the data both within the intervention groups and within the usual-care groups. The 6-month intervention for smoking cessation and diet improvement involves a behavior-change counselor working with participants to encourage and support change of one or both of these two risk behaviors (depending on experimental condition). The counselor will employ self- determination theory principles, which include eliciting and acknowledging the patients' perspectives and values, providing choices and relevant information, promoting perceived competence, and minimizing pressure to change. The intervention, which is consistent with and builds upon the AHCPR guidelines for smoking cessation and the NCEP guidelines for lowering cholesterol was designed to operationalize the positions of self-determination theory so its applicability to change of these two health-risk behaviors could be tested. Outcomes assessed at 6 and 18 months include 7-day point prevalence smoking cessation (validated by serum cotinine), reduction in percentage of calories from rat assessed by 24 dietary recalls, and improvement in measured and calculated LDL cholesterol.