Reducing Tobacco Related Health Disparities

摘要 这项拟议的研究将评估一种理论上和经验上的有效性和成本效益， 基于“动机和解决问题”（MAPS）的干预，以促进和促进戒烟 低收入的吸烟者，他们不想戒烟。约90%的当前吸烟者（超过4100万） 人们）在任何一个时间点都没有准备好戒烟。MAPS是一种全面、动态的方法， 利用动机增强和社会认知相结合的方法促进行为改变 基于动机访谈（MI）的治疗烟草使用和依赖的临床实践 社会认知理论。MAPS专为所有吸烟者设计，无论他们是否准备戒烟 或戒烟过程的阶段，并特别针对动机和内在动机的变化，社会 认知结构（例如，（三）与低收入特别相关的其他关键因素 吸烟者（例如，压力、家庭问题、财政资源）。因为MAPS包含了一种慢性护理类型， 治疗烟草使用的方法，并围绕着一个“健康计划”，解决了许多障碍 以及低收入人士普遍关注的问题，我们认为， 这样的吸烟者。 参与者（N = 900）将是在Harris经营的社区健康诊所就诊的吸烟者 县医院区（HCHD）。HCHD是服务于休斯顿和哈里斯的安全网公共卫生保健系统 县，全国第四大城市和第三人口最多的县。HCHD只为没有保险的人服务， 保险不足所有参与者将接受为期两年的随访，并将被随机分配到 三组：1）标准治疗[ST]，2）MAPS-4，或3）MAPS-8。ST将包括一封信， 吸烟者到德州戒烟热线，和标准的自助材料。ST将总共发生4次（基线、6、12、14、16、17、18、19 18个月）。MAPS-4将包括ST加4个积极的MAPS电话咨询会议，为期2- 年期间。MAPS-8将包括ST加8个积极的电话咨询会议，为期2年。 将在基线时和基线后6、12、18和24个月进行评估。主要结局 变量为6个月、12个月、18个月和24个月随访期间以及24个月时的戒烟率。 随访次要结局将包括戒烟尝试和德克萨斯戒烟热线的使用。

ABSTRACT The proposed study will evaluate the efficacy and cost-effectiveness of a theoretically- and empirically- based "Motivation And Problem Solving" (MAPS) intervention for promoting and facilitating smoking cessation among low income smokers who are not ready to quit. Approximately 90% of current smokers (over 41 million people) are not ready to quit smoking at any one point in time. MAPS is a holistic, dynamic approach to facilitating behavior change that utilizes a combined motivational enhancement and social cognitive approach based on motivational interviewing (MI) the Treating Tobacco Use and Dependence Clinical Practice Guideline, and social cognitive theory. MAPS is designed for all smokers regardless of their readiness to quit or phase of the quitting process, and specifically targets motivation and intrinsic motives for change, social cognitive constructs (e.g., agency/self-efficacy), and other key factors of particular relevance to low income smokers (e.g., stressors, family issues, financial resources). Because MAPS encompasses a chronic care type approach to treating tobacco use and revolves around a "wellness program" that addresses numerous barriers and concerns that are prevalent among low income individuals, we believe it is particularly appropriate for treating such smokers. Participants (N = 900) will be cigarette smokers attending community health clinics operated by the Harris County Hospital District (HCHD). HCHD is the safety net public health care system serving Houston and Harris County, the nation's fourth largest city and third most populous county. HCHD serves only the uninsured and underinsured. All participants will be followed for a period of two years, and will be randomly assigned to one of three groups: 1) Standard Treatment [ST], 2) MAPS-4, or 3) MAPS-8. ST will consist of a letter referring smokers to Texas Quitline, and standard self-help materials. ST will occur a total of 4 times (Baseline, 6, 12, and 18 months). MAPS-4 will consist of ST plus 4 proactive MAPS telephone counseling sessions over a 2- year period. MAPS-8 will consist of ST plus 8 proactive telephone counseling sessions over a 2-year period. Assessments will occur at Baseline and at 6, 12, 18, and 24 months after Baseline. The primary outcome variables are abstinence from tobacco across the 6, 12, 18, and 24-month follow-ups, and at the 24-month follow-up. Secondary outcomes will include quit attempts and use of the Texas Quitline.