Can Motivational Interviewing be Effective for Smoking Cessation?

描述（由申请人提供）：在美国，吸烟仍然是最重要的可预防的死亡原因之一。尽管大多数吸烟者对戒烟感兴趣，但只有五分之一的人准备在任何时间点戒烟。不幸的是，很少有旨在提高不准备戒烟的吸烟者的动机或准备程度的干预措施。动机访谈（MI）是一种专注于增强行为改变动机和承诺的干预方法。心肌梗死已被证明对解决各种成瘾和健康行为有效，然而，戒烟的研究结果却非常消极，所有先前的研究都有明显的局限性。先前研究的一个重要限制是，它们的设计不是为了直接测试心肌梗死是否对不准备戒烟的吸烟者更有效，特别是心肌梗死是否在激励戒烟尝试方面更有效。此外，几乎所有的研究都集中在特殊人群，如公共住房居民、青少年和精神疾病患者，他们中的许多人在戒烟方面面临着严重的环境和生理障碍。因此，本研究的主要目的是在普通成年吸烟者的样本中检验心肌梗死对激励尚未准备戒烟的吸烟者戒烟尝试的有效性。我们将随机分配符合条件的吸烟者进行动机性访谈（MI），基于PHS指南的咨询控制（GBC）或简短建议（BA）。主要结果将是在随机分组和6个月随访期间至少持续24小时的任何自我报告的戒烟尝试的发生（或不发生）。次要目的是检查两组之间6个月的随访戒烟率，以便提供一个效应量估计，可用于设计一个以戒烟为主要结果的大规模研究。BA的参与者将在7周内接受1次培训，MI和GBC的参与者将接受5次单独培训（2次面对面培训，3次电话培训）。所有决定戒烟的参与者将获得伐尼克兰（Chantix）。我们计划需要招募255名不准备戒烟的吸烟者来检测拟议的治疗效果。公共卫生相关性：吸烟仍然是美国最重要的可预防的死亡原因之一，尽管大多数吸烟者对戒烟感兴趣，但五分之四的人没有准备好在任何给定的时间点戒烟。这个项目通过测试一种被称为动机性访谈的新型咨询方法来解决缺乏旨在提高戒烟准备度的方法的问题。潜在的公共卫生影响是巨大的，因为它可以将有效的戒烟干预措施扩大到大多数没有动力的吸烟者，并缩短开始吸烟和戒烟之间长达数十年的滞后时间。

DESCRIPTION (provided by applicant): Tobacco smoking remains one of the most significant preventable causes of death in the U.S. Although most smokers are interested in quitting, only one in five are ready to make a quit attempt at any point in time. Unfortunately, few interventions designed to enhance motivation or readiness among smokers who are not ready to quit are available. One intervention method that focuses on enhancing motivation for and commitment to behavior change is Motivational Interviewing (MI). MI has been shown to be effective for addressing a variety of addictive and health behaviors, however findings for smoking cessation have been overwhelmingly negative and all prior studies have significant limitations. One important limitation of prior studies is that they were not designed to directly test whether MI is more effective for smokers who are not ready to quit, and in particular, whether MI was more effective at motivating quit attempts. Moreover, nearly all focused on special populations such as public housing residents, adolescents, and people with mental illness, many of whom face significant environmental and physiological barriers to quitting. Therefore, the primary aim of this study is to test, among a sample of general adult smokers, the effectiveness of MI for motivating quit attempts among smokers not yet ready to quit. We will randomly assign eligible smokers to Motivational Interviewing (MI), a PHS Guidelines-based counseling control (GBC), or brief advice (BA). The primary outcome will be the occurrence (or not) of any self-reported quit attempt lasting at least 24 hours between randomization and 6 month follow-up. The secondary aim will be to examine 6 month follow-up quit rates between the groups in order to provide an effect size estimate that could be used in designing a large scale study with a primary outcome of smoking cessation. Participants in BA will receive 1 session and participants MI and GBC will receive 5 individual sessions (2 in-person, 3 phone) over 7 weeks. All participants who decide to quit will be provided with varenicline (Chantix). We project needing to enroll 255 smokers who are not ready to quit to detect the proposed treatment effect. PUBLIC HEALTH RELEVANCE: Tobacco smoking remains one of the most significant preventable causes of death in the U.S. and although most smokers are interested in quitting, four in five are not ready to make a quit attempt at any given point in time. This project addresses the lack of methods designed to increase readiness to quit by testing a novel counseling method known as Motivational Interviewing. The potential public health impact is large because it could extend the reach of effective cessation interventions to the majority of smokers who are unmotivated and reduce the decades-long lag between smoking initiation and cessation.