Self-Determination and Maintaining Tobacco Abstinence

自我决定和保持戒烟

• 批准号: 6878510
• 负责人: Geoffrey C Williams
• 金额: $ 62.78万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-04-01 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6878510
• 关键词: behavioral /social science research tag; clinical research; clinical trials; community; counseling; drug /alcohol abstinence; human subject; human therapy evaluation; motivation; patient oriented research; psychobiology; quality of life; self care; smoking; smoking cessation; social behavior; social psychology; tobacco abuse education; tobacco abuse prevention

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.

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)的咨询干预措施的审查扩展到持续戒烟的问题。提出了两个项目，这两个项目都是以我们目前的试验结果为基础的。第一项是对当前试验中患者吸烟状况的32个月跟踪调查。与社区护理相比，SDT干预在6个月时有效，根据初步分析，在18个月时对维持也有效，但需要长期(32个月)的随访数据。第二个项目是3细胞临床试验。目前的结果显示，如果患者使用已知的戒烟有效药物，他们在6个月前戒烟的可能性是其他患者的四倍，所以这项试验将检查当前干预的两个扩展，这两个扩展都更加强调使用和坚持戒烟药物。这两个手臂将被比作社区护理。双方都需要两次去看医生，讨论药物和副作用。在这两种干预措施中，咨询师都将解决服药依从性问题。这两个手臂的不同之处在于，没有准备好在一只手臂上戒烟的患者将接受一种(通过药物)戒烟的方法，在这种方法中，他们首先尝试将吸烟减少一半，然后尝试戒烟。除了更多地强调用药和检查用药依从性作为维持戒烟的中介外，干预措施将有两个主要变化，旨在促进长期维持。首先，干预将持续12个月(而目前的干预只持续6个月)，在额外的时间内举行会议，重点是维持和预防复发。其次，将鼓励每个患者的至少一名家庭成员或最好的朋友与咨询师会面，学习如何在与烟草相关的问题上更自主地支持患者。我们目前的结果表明，家庭自主支持预示着戒烟，而家庭成员是长期维持禁欲的重要支持来源。停止和维持禁欲将通过Logistic回归和生存曲线分析进行检验。将使用结构方程模型对维持戒烟的SDT过程模型进行检验，并对干预措施进行成本-效果分析。