SELF DETERMINATION, SMOKING, DIET, AND HEALTH

临床试验将测试(1)与常规护理相比，源自自我决定理论并应用于戒烟、改善饮食或两者兼而有之的干预措施；(2)维持健康行为改变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（该目标随健康和风险状况的变化而变化）进行分层。那些达到目标的人将被随机分配到自我决定干预组或常规戒烟护理组。那些没有达到目标的人将被随机分配到四种条件中的一种，这些条件是由自我决定干预与减少饮食脂肪摄入量的常规干预的因子交叉产生的。因此，我们将测试自我决定理论干预对戒烟、饮食改善和两者的影响。此外，使用结构方程模型，我们将测试自决模型对干预组和常规护理组数据的拟合。为期6个月的戒烟和饮食改善干预包括行为改变顾问与参与者一起工作，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）。咨询师将运用自我决定理论原则，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，并尽量减少改变的压力。该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，旨在实施自我决定理论的立场，以便测试其对改变这两种健康风险行为的适用性。在6个月和18个月时评估的结果包括7天的点流行戒烟（通过血清可替宁验证），通过24次饮食回顾评估的大鼠卡路里百分比减少，以及测量和计算的LDL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.