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 以“动机和问题解决”(MAP)为基础的促进和促进戒烟干预 在不准备戒烟的低收入吸烟者中。约90%的当前吸烟者(超过4100万 人们)还没有准备好在任何一个时间点戒烟。地图是一种整体的、动态的方法 促进行为改变，利用激励增强和社会认知相结合的方法 基于动机访谈治疗烟草使用和依赖的临床实践 指导思想和社会认知理论。MAP专为所有吸烟者设计，无论他们是否准备戒烟 或退出过程的阶段，并具体针对变革的动机和内在动机，社会 认知结构(例如，代理/自我效能)，以及与低收入特别相关的其他关键因素 吸烟者(例如，压力源、家庭问题、经济来源)。因为地图包含一种慢性护理类型 一种治疗烟草使用的方法，并围绕着一项解决无数障碍的“健康计划” 以及在低收入个人中普遍存在的担忧，我们认为特别适合 治疗这样的吸烟者。 参加者(N=900)为吸烟人士，前往哈理斯会辖下的社区健康诊所求诊 县医院区(HCHD)。HCHD是为休斯顿和哈里斯服务的安全网公共卫生保健系统 县，全国第四大城市和第三大人口县。HCHD只为未参保和 保险不足。所有参与者将被跟踪两年，并将被随机分配到以下其中之一 三组：1)标准治疗[ST]，2)MAP-4，或3)MAP-8。ST将由一封推荐信组成 吸烟者到德克萨斯Quitline，和标准的自助材料。ST段共发生4次(基线，6，12， 和18个月)。MAP-4将由ST加4个主动MAP电话咨询会话组成，超过2- 一年期间。MAP-8将包括ST和8次主动电话咨询，为期两年。 评估将在基线以及基线后6、12、18和24个月进行。主要结果是 变量是6个月、12个月、18个月和24个月的随访以及24个月的戒烟情况 后续行动。次要结果将包括戒烟尝试和使用德克萨斯Quitline。

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.