Spirometry to Motivate Quit-Smoking Attempts: Message Development and Testing

描述(申请人提供)：在工业化国家，吸烟是可预防疾病的主要原因，特别是心血管和呼吸系统疾病，以及癌症。2000年，美国卫生与公众服务部发布了一份关于治疗烟草使用和依赖的循证临床实践指南，其中规定，吸烟但不愿戒烟的患者应该接受干预，以增强他们戒烟的动力。列出的动机中包括强调吸烟的风险。其中一个风险是肺功能下降，这是通过肺活量测定法测量的。然而，肺活量测定有助于戒烟的证据是有限的。医疗研究和质量机构(AHRQ)最近得出结论，现有证据不支持在初级保健环境中使用肺活量测量来提高戒烟率。尽管如此，认识到这一工具的潜在重要性，AHRQ将随机对照试验的必要性列为未来研究的优先事项，以确定肺活量测定在戒烟中的作用。在进行这样的对照试验之前，我们需要了解为什么肺活量测定没有被证明能令人信服地促进戒烟。我们认为，肺活量测量在这方面失败的主要原因是，在戒烟重要性的背景下，测量的意义没有有效地传达给吸烟的患者。为了验证这一假设，我们设计了这项建议，以开发一种增强的[肺活量测量干预，包括激励信息和后续信件]，然后测试这种[干预]对戒断尝试比率的影响。我们假设，与通过标准的[干预]提供这些结果相比，通过增强的[肺活量测量干预]向当前吸烟者提供肺功能知识将增加戒烟尝试的比率。我们的3个具体目标是：1)利用行为学和沟通理论的原理，开发关于肺活量测定的增强的激励信息；2)确定通过增强的[肺活量测定干预]向当前吸烟者提供肺活量测定结果对戒烟尝试率的影响；3)确定哪些临床特征与戒烟尝试有关，并找出肺活量测定在提高戒烟率方面的有效性的障碍。这些数据将为未来开展肺活量测定戒烟有效性的大型临床试验提供框架。吸烟是世界上与癌症相关的死亡的主要原因。因此，戒烟是癌症控制中最重要的行为干预措施。该项目将确定测量吸烟者的肺功能并使用强有力的激励策略将结果提供给他们是否会增加他们尝试戒烟的可能性。如果是这样，那么这一策略可以用于大规模研究，以确定肺功能结果在促使人们戒烟方面是否有效。

DESCRIPTION (provided by applicant): Smoking is a leading cause of preventable disease in industrialized countries, especially cardiovascular and respiratory illness, and cancer. In 2000, the US Department of Health and Human Services issued an evidenced-based Clinical Practice Guideline on Treating Tobacco Use and Dependence that states that patients who smoke, but are unwilling to quit, should receive an intervention that increases their motivation to quit. Among the motivations listed is highlighting the risks of cigarette smoking. One of these risks is decreased lung function as measured by spirometry. However, the evidence that spirometry enhances smoking cessation is limited. The Agency for Healthcare Research and Quality (AHRQ) recently concluded that the available evidence does not support the use of spirometry in the primary care setting in order to improve smoking cessation rates. Nonetheless, in recognition of the potential importance of this tool, the AHRQ lists the need for randomized controlled trials to determine the role of spirometry in smoking cessation as a priority of future research. Before such controlled trials can take place, we need to understand why spirometry has not been shown to convincingly enhance smoking cessation. We believe that the primary reason spirometry has failed in this regard is because the meaning of the measurement in the context of the importance of smoking cessation is not effectively communicated to the patient who smokes. To test this hypothesis, we have designed this proposal to develop an enhanced [spirometry intervention, to include a motivational message and follow-up letter], and then test the impact of this [intevention] on the quit attempt rate. We hypothesize that providing knowledge of lung function to current smokers through an enhanced [spirometry intervention] will increase the quit attempt rate compared to delivery of these results through a standard [intervention]. Our 3 Specific Aims are: 1) To develop an enhanced motivational message about spirometry using principles of behavioral and communication theory; 2) To determine the effect of delivering spirometry results to current smokers through an enhanced [spirometry intervention] on the quit attempt rate; 3) To determine which clinical characteristics are associated with quit attempts, and identify barriers to the effectiveness of spirometry in enhancing the quit attempt rate. These data will provide the framework for developing a future large clinical trial of the effectiveness of spirometry on smoking cessation. Cigarette smoking is the leading cause cancer-related death in the world. Therefore, quitting smoking is the most important behavioral intervention in cancer control. This project will determine whether measuring lung function in smokers and delivering the results to them using a strong motivational strategy will increase the likelihood that they will try to stop smoking. If so, then this strategy can be used in a large scale study to determine whether lung function results are effective in getting people to quit smoking.