Motivating Smokers with Mobility Impairments to Quit Smoking

摘要 肢体残疾人士的健康状况与其他弱势群体相似(例如， 没有保险，获得医疗和预防护理的机会减少，合并疾病更多)，但明显减少 他们的健康促进受到了重视。虽然戒烟干预措施已经开发出来， 在其他弱势群体中，没有一种是为肢体残疾人士提供的。身体残障人士 (活动障碍)使用辅助行走的人吸烟率(32.5%)高于 残疾人和不需要援助的人(23%)和非残疾人(19.8%；Brawarsky等人)。 2002年)。本研究的目的是：1)开发一系列以理论为基础的干预DVD，重点是 在行动不便人士中鼓励戒烟(例如，长期使用某种 辅助行走，如助行器、拐杖、轮椅、背带等)和2)测试干预效果 在一项随机试验中，对560名行动不便的吸烟者进行了DVD与基于印刷的标准护理的比较。这个 这两个组的材料将按月邮寄，为期四个月，并单独组织 根据退出的准备情况节。两组参与者都将获得a)免费尼古丁贴片，条件是 他们准备退出，b)在两封邮件之间打个简短的电话(~5分钟)，以评估和鼓励观看 材料。我们假设，随机接受干预DVD的吸烟者将是 更有可能在1、6和12个月内实现7天和30天的时点戒断 随访与那些接受基于打印的标准护理的人。干预性DVD将基于 行为激活理论，并解决这一人群中戒烟的特定障碍(增加的压力， 减少积极情绪、增加抑郁情绪、限制活动和自我效能)。我们假设 干预将直接影响这些调解人，也会通过行为激活间接影响这些调解人 (目标设定和愉快的事件)。我们的一系列初步研究支持使用这些调解人 行动不便的人和使用DVD作为可接受的干预模式，考虑到 这部分人口的经济和流动性限制。如果有效，我们的DVD干预可能会有很高的水平 具有公共卫生和临床意义，因为它可以很容易地通过国家 与残疾相关的组织、独立生活中心网络或医生办公室，以及实质上 提高肢体残疾人士的健康和生活质量。这项研究是创新的，因为没有 研究针对这一人群，将行为激活理论应用于戒烟，它 研究吸烟领域中相对新颖的媒介(例如，积极的情感、行为的激活)。

Abstract People with physical disabilities experience similar health disparities as other disadvantaged groups (e.g., no insurance, decreased access to medical and preventive care, more co-morbidities) but significantly less attention is paid to their health promotion. While smoking cessation interventions have been developed for other disadvantaged groups, none exist for people with physical disabilities. People with physical disabilities (mobility impairments) who use assistance to ambulate have higher smoking rates (32.5%) than people who have a disability and do not need assistance (23%) and people who are not disabled (19.8%; Brawarsky et al. 2002). The aims of the current study are to: 1) develop a series of theory-based intervention DVDs focused on motivating smoking cessation among people with mobility impairments (i.e., chronically use some type of assistance to walk such as walker, cane, wheelchair, braces, etc) and 2) test the efficacy of the Intervention DVDs vs. Print-based Standard Care among 560 smokers with mobility impairments in a randomized trial. The materials in both groups will be mailed on a monthly basis for four months, and are organized in separate sections according to readiness to quit. Participants in both groups will receive a) nicotine patches at no cost if they are ready to quit and b) brief phone calls (~5 minutes) between mailings to assess and encourage viewing the materials. We hypothesize that smokers who are randomized to receive the Intervention DVDs will be significantly more likely to achieve 7-day and 30-day point-prevalence abstinence at 1, 6, and 12- month follow-ups vs. those who receive Print-based Standard Care. The Intervention DVDs will be based on Behavioral Activation Theory, and address specific barriers to quitting in this population (increased stress, decreased positive affect, increased depressed mood, activity restriction, and self-efficacy). We hypothesize that the intervention will impact these mediators directly, as well as indirectly through Behavioral Activation (goal setting and pleasant events). Our series of preliminary studies support the use of these mediators for people with mobility impairments and the use of DVDs as an acceptable mode of intervention, given the economic and mobility limitations of this population. If effective, our DVD intervention could have a high level of public health and clinical significance, as it could be easily disseminated at low cost through national disability-related organizations, networks of independent living centers, or physician offices, and substantially improve the health and quality of life for people with physical disabilities. This study is innovative because no studies have targeted this population, it applies Behavioral Activation Theory to smoking cessation, and it examines relatively novel mediators in the field of smoking (e.g., positive affect, behavioral activation).