Elective Surgery as a Teachable Moment for Smoking Cessation

描述(申请人提供)：“可教时刻”是指激励个人自发地采取降低风险的健康行为的事件。诸如诊断与吸烟有关的疾病(如癌症)和自发安排手术(即在没有干预的情况下)等事件会增加戒烟率。然而，正如McBride等人最近在一篇重要的概念性论文中所讨论的那样，人们对使某些线索事件“可教”的因素知之甚少。他们提出了一个启发式的方法，即一个事件是戒烟的“可教时刻”，因为它影响了三个关键结构。虽然在概念上很有吸引力，但其有效性尚未得到评估。手术的时间安排为测试麦克布莱德模型提供了一个独特的机会。这项研究将评估麦克布莱德启发式在择期手术后的吸烟行为中的应用。我们将追求两个具体目标。首先，我们将开发特定于手术环境的MeBride模型的测量方法，并在一组手术患者中对其稳定性和内部一致性进行初步评估。在第二项研究中，我们将进行一项初步研究，以探索如下假设：在计划接受择期手术的患者中，1)对与吸烟相关的健康后果的风险感知或更多负面预期，2)更高水平的积极或消极情感反应，以及3)与吸烟相关的自我概念或角色期望将与自我效能和意图的测量相关，并预测术后戒烟。麦克布莱德结构的测量将应用于计划进行择期手术的吸烟者，他们的吸烟行为将在术后长达30天的时间内接受评估。结构方程模型将被用来验证在目标1中建立的测量模型，并测试与McBride启发式相关联的结构模型对术后吸烟行为的适合性。与公共健康相关：对McBride启发式的评估不仅从理论角度来看是有意义的，而且可能对设计行为干预措施以利用“可教的时刻”具有实际意义。例如，如果结构预测行为，干预措施可以尝试特定地影响这些结构。我们的总体目标是为外科患者开发有效的烟草使用干预措施；这个项目将是这一过程中的重要一步。

DESCRIPTION (provided by applicant): The term "teachable moment" refers to an event that motivates individuals to spontaneously adopt risk- reducing health behaviors. Events such as the diagnosis of smoking-related illnesses (e.g. cancer) and the scheduling of surgery spontaneously (i.e., in the absence of interventions) increase the rate of quitting. However, as recently discussed in an important conceptual paper by McBride et al, little is known about factors that make certain cueing events "teachable". They proposed a heuristic in which an event is a "teachable moment" for smoking cessation to the extent that it impacts 3 key constructs. Although appealing in concept, its validity has not been evaluated. The scheduling of surgery provides a unique opportunity to test the McBride model. This study will evaluate the McBride heuristic as applied to smoking behavior following elective surgical procedures. Two specific aims will be pursued. In the first we will develop measures of the Me Bride model specific to the surgical setting, and perform an initial evaluation of their stability and internal consistency in a group of surgical patients. In the second, we will perform a pilot study to explore the hypothesis that in patients scheduled for elective surgery: 1) higher perceptions of risks or greater negative expectancies regarding health outcomes related to smoking, 2) higher levels of positive or negative affective responses, and 3) self-concept or role expectations related to smoking will correlate with measures of self-efficacy and intent, and predict postoperative abstinence from smoking. Measures of the McBride constructs will be administered to smokers scheduled for elective surgery, whose smoking behavior will be evaluated for up to 30 days postoperatively. Structural equation modeling will be utilized both to validate the measurement model established in Aim 1 and to test the fit of the structural model associated with the McBride heuristic to postoperative smoking behavior. Relevance to public health: Evaluation of the McBride heuristic is of interest not only from a theoretical standpoint, but may have practical implications regarding the design of behavioral interventions to exploit the "teachable moment. For example, if the constructs predict behavior, interventions can attempt to specifically influence these constructs. Our overall goal is to develop effective tobacco use interventions for surgical patients; this project will be an important step in this process.