Effects of Message Framing on Cessation among Couples where both Partners Smoke

描述(由申请人提供)：双方成员都吸烟的夫妇是戒烟干预的主要目标。在这些人中，戒烟率较低，复发率较高，由于暴露在伴侣吸烟的环境中，每个人的健康风险都会放大。作为一项促进戒烟的战略，尽管存在这些事实，但信息框架干预措施并没有强调吸烟结果与健康、外表和经济状况有关的情况可能会如何影响夫妻双方。对于双方都吸烟的夫妇，干预信息可以强调戒烟的积极结果(即积极框架)或不戒烟的成本(即消极框架)如何影响个人吸烟者或夫妇。这项研究扩展了先前的框架研究，考察了关注个人和夫妇层面结果的得失框架信息如何影响(A)信息接受，通过对信息准确性、可信度和结果相关性的评估来实现；(B)在个人和关系层面上成功戒烟的可能中介， 包括意图、风险认知、自我和二元效能，以及通过自我报告和在关于戒烟的夫妇对话中使用第一人称复数代词(WE-Talk)来操作的社区应对；以及(C)通过生化验证的6个月内吸烟行为的变化。参与者将是120对夫妇(已婚或已婚、同性和异性)，其中成员都吸烟，且在接下来的30天内都不打算戒烟。我们将在2x2析因设计中将配对随机分配到4个细胞中的1个，该设计通过 关注自我与伴侣的结果。具体的干预操作将通过书面叙述、关键框架点总结和初始干预会议一周后提供的助推信息来实施和加强。除了随机化前的基线评估外，夫妇们还将完成干预后立即进行的调查，评估信息接受程度以及假想的个人和关系调解人；参与干预后关于吸烟的联合访谈(随后通过自动文本分析得出“我们交谈”的记录)；并在1个月和6个月后提供跟踪数据，以评估结果，如戒烟意图、吸烟量和戒烟。我们假设：(A)关注夫妻层面的结果的框架信息比关注个人层面的结果的框架信息在激励戒烟方面更有效；(B)以获得为框架的信息将比以损失为框架的信息更有说服力，特别是当信息的结果焦点是夫妇时；(C)以夫妇为中心的信息将最有效地促使假想的关系变化机制，如二元效能和集体应对；以及(D)所有这些关联在高关系质量的夫妇中会更强。如果结果为这些新的和未调查的假说提供了初步支持，效应大小估计将被用来提出更大的随机试验。这项研究将为信息框架在临床实践和公共卫生中的新应用增加重要的战略见解，当高危目标群体是伴侣双方都吸烟的时候。

DESCRIPTION (provided by applicant): Couples in which both members smoke represent key targets for smoking cessation interventions. Quit rates are lower and relapse rates are higher among these individuals, and each person's health risks are amplified due to exposure to their partner's smoking. As a strategy to promote quit, and despite these facts, message framing interventions have not highlighted how smoking outcomes related to health, appearance and finances might affect both partners in a couple jointly. For couples in which both partners smoke, intervention messages can highlight how positive outcomes of quitting (i.e., positive frame) or costs of not quitting (i.e., negative frame) affect the individual smoker or the couple. This study extends prior framing research by examining how gain- versus loss-framed messages focused on individual- versus couple-level outcomes influence (a) message acceptance, operationalized by evaluations of message accuracy, credibility and outcome relevance; (b) likely mediators of successful cessation at both individual and relationship levels, including intentions, risk perceptions, self- and dyadic efficacy, and communal coping operationalized both by self-report and first person plural pronoun use (we-talk) in a couple conversation about quitting; and (c) smoking behavior change over 6 months, verified biochemically. Participants will be 120 couples (married or living as married, same and opposite sex) in which both members smoke and neither plans to quit during the next 30 days. We will randomize couples to 1 of 4 cells in a 2 x 2 factorial design that crosses gain vs. loss frame with self vs. couple outcomes focus. The specific intervention manipulations will be implemented and reinforced via written narratives, summaries of key framing points, and booster messages given 1 week after the initial intervention session. In addition to a baseline assessment before randomization, couples will complete an immediate post-intervention survey assessing message acceptance plus hypothesized individual and relational mediators; participate in a joint post-intervention interview about smoking (with transcripts later yielding "we-talk" via automatic text analysis); and provide follow-up data 1 and 6 months later to assess outcomes such as intentions to quit, amount smoked, and cessation. We hypothesize that (a) framed messages focused on couple- rather than individual-level outcomes will be more effective in motivating quitting; (b) gain-framed messages will be more persuasive than loss-framed messages, especially when the message outcome focus is the couple; (c) couple-focused messages will be most effective in prompting hypothesized relational change mechanisms such as dyadic efficacy and communal coping; and (d) all these associations will be stronger in couples with high relationship quality. If results provide preliminary support for these novel and uninvestigated hypotheses, effect size estimates will be used to propose a larger randomized trial. This research should add important strategic insights to new applications of message framing in clinical practice and public health when the high-risk target group is couples in which both partners smoke.