Self-Determination and Maintaining Tobacco Abstinence

描述（由申请人提供）：本申请（RFA # OB-03-003）将我们对基于自我决定理论（SDT）的咨询干预的检查扩展到维持戒烟的问题。提出了两个项目，这两个项目都建立在我们目前的试验结果的基础上。首先是对目前试验中患者的吸烟状况进行32个月的随访。相对于社区护理，SDT干预在6个月时有效，并且根据初步分析，在18个月时维持也有效，但需要长期（32个月）随访数据。第二个项目是3细胞临床试验。目前的结果表明，如果患者使用已知有效的戒烟药物，那么他们在6个月内戒烟的可能性增加了4倍，因此该试验将检查当前干预措施的两个扩展，这两个扩展都更加强调使用和坚持戒烟药物。这两个部门将与社区护理进行比较。两组都需要与医生进行两次会面，讨论药物和副作用。在这两种干预措施中，顾问将解决药物依从性问题。两组的不同之处在于，一组中没有准备好戒烟的患者将接受减少吸烟的方法（使用药物），他们首先尝试将吸烟量减少一半，然后尝试戒烟。除了更加强调药物治疗和检查药物依从性作为维持戒烟的中介外，旨在促进长期维持的干预措施将有两个主要变化。首先，干预将持续12个月（而目前的干预仅持续6个月），在额外的时间内举行会议，重点关注维持和复发预防。第二，鼓励每位患者的至少一名家庭成员或最好的朋友与顾问会面，学习如何在与烟草有关的问题上更自主地支持患者。我们目前的研究结果表明，家庭自主的支持预测戒烟，家庭成员是长期维持禁欲的重要支持来源。将使用逻辑回归和生存曲线分析来检查戒烟和维持戒烟。将使用结构方程模型测试维持戒烟的SDT过程模型，并对干预措施进行成本效益分析。

DESCRIPTION (provided by applicant): This application (RFA # OB-03-003) extends our examination of self-determination theory (SDT) based counseling interventions to the issue of maintained abstinence from tobacco use. Two projects are proposed, both of which build on the results of our current trial. The first is a 32-month follow-up of the smoking status of patients in the current trial. The SDT intervention was effective at 6 months relative to community care, and, according to preliminary analyses, was also effective for maintenance at 18 months, but long-term (32-month) follow-up data are needed. The second project is a 3-cell clinical trial. The current results show that patients were four times more likely to quit by 6 months if they used medications known to be efficacious for cessation, so the trial will examine two extensions of the current intervention, both of which place greater emphasis on use of, and adherence to, cessation medications. The two arms will be compared to community care. Both arms involve two visits with a physician to discuss medications and side effects. In both interventions, counselors will address medication adherence. The two arms differ in that patients not ready to quit in one arm will receive a smoking reduction approach (with medications) in which they first try to reduce their smoking to half and then attempt cessation. In addition to greater emphasis on medications and examination of medication adherence as a mediator of maintained cessation, there will be two major changes in the intervention intended to facilitate long-term maintenance. First, the intervention will extend over 12 months (whereas the current one lasts only 6 months) with meetings during the additional time focusing on maintenance and relapse prevention. Second, at least one family member or best friend of each patient will be encouraged to meet with a counselor to learn how to be more autonomy supportive with the patient around issues related to tobacco. Our current results show that family autonomy support predicts cessation, and family members represent an important source of support for long-term maintenance of abstinence. Cessation and maintained abstinence will be examined with logistic regression and survival curve analyses. The SDT process model of maintained cessation will be tested using structural equation modeling, and cost-effectiveness analyses will be done for the interventions.