Effect of Helpers Program On-line Training on Smoking Relapse and Social Networks

摘要 尽管戒烟治疗取得了重大进展，但最近戒烟的吸烟者中有一半以上将在 第一年。两项对复发预防研究的系统评价得出了关于有效性的不同结论 行为干预的结果。现有的预防复发的证据受到研究设计、方法、 以及行为干预的概念性方法。对复发预防研究的不同方法， 而且，需要干预措施本身来促进对以下各项的长期理解和成果 预防吸烟复发。到目前为止，预防复发的干预措施主要集中在新戒毒者 吸烟者(“戒烟者”)，不试图直接或间接影响戒烟者的个人关系网 (PN)，例如，通过帮助弃权者影响他们的PN中的其他人戒烟。个人网络发挥强大作用 对开始和保持吸烟行为的影响，并有助于保持戒烟或触发 旧病复发。一种旨在提高戒烟者影响吸烟者健康的“帮助他人”干预措施 戒烟的PN--从而创造一个更支持长期禁欲的PN社会环境--可能有 对复发的有益效果。帮工sq干预活动鼓励戒酒者加强自己的能力。 通过帮助他人戒烟，并主动影响自己的PN，使其更有利于长期 戒烟。将复发视为一个动态而复杂的过程，帮助者保持戒烟(帮助者SQ) 干预是一种融合了不同行为理论的预防复发的概念上的新方法 转化为多方面的干预模式，作为在线戒烟简短干预培训。 Helpers SQ教戒烟者如何鼓励其他烟草使用者戒烟，并通过非吸烟者的 对抗性“帮助谈话”(HC)，鼓励戒烟和使用基于证据的戒烟辅助工具 (如戒断、戒断药物)，没有对抗和唠叨。我们的佣工试验可行性研究 SQ(N=104)与来自亚利桑那州戒毒线的戒毒者比较了7个月内禁欲30天与 倾向分数与未接触帮手SQ的QuiLine客户的样本相匹配。初步结果：帮助者 SQ参与者报告的30天禁酒率高于非参与者(82%对36%，差异=46% [95%CI：37%，56%，p&lt；0.0001])。受到这些结果的鼓舞，我们假设戒毒者暴露在 与那些接受戒毒治疗的人相比，To Helpers SQ将有更高的30天和7天点戒断流行率 后续的日常护理，并认为帮助者SQ的影响可能是通过PN的特征来调节的。为了测试这一点 假设，我们提出了一个实用的随机对照试验(N=940)，嵌入混合方法PN 辅助者SQ培训对戒酒者戒酒比例和戒断持续时间影响的研究 时间，以及戒烟者与吸烟和戒烟相关的PN交互作用。派生自 PN研究将被用来对帮手SQ对吸烟的总体和基于性别的影响进行中介分析 旧病复发。

Abstract Despite major gains in smoking cessation treatment, over half of recently quit smokers will relapse within the first year. Two systematic reviews of relapse prevention studies came to different conclusions on effectiveness of behavioral interventions. Existing evidence in relapse prevention is limited by study designs, methodology, and conceptual approaches to behavioral interventions. Different approaches to relapse prevention studies, and to the interventions themselves are needed to advance the long-term understanding and outcomes of smoking relapse prevention. To date, relapse prevention interventions have focused on the newly abstinent smoker (“abstainer”), and not attempted to directly or indirectly influence the abstainer’s personal network (PN), e.g. by helping the abstainer influence others in their PN to quit. Personal networks exert powerful effects on initiating and maintaining smoking behavior, and can facilitate maintaining abstinence or trigger relapse. A “help others” intervention that seeks to increase the abstainer’s ability to influence smokers in their PN to quit – thereby creating a PN social environment more supportive of long-term abstinence - may have a beneficial effect on relapse. The Helpers SQ intervention encourages abstainers to reinforce their own abstinence through helping others quit, and to proactively influence their PN to be more conducive to long-term smoking abstinence. Framing relapse as a dynamic and complex process, the Helpers Stay Quit (Helpers SQ) intervention is a conceptually novel approach to relapse prevention that integrates different behavioral theories into a multifaceted intervention model presented as an on-line tobacco cessation brief intervention training. Helpers SQ teaches abstainers how to encourage other tobacco users to quit and avoid relapse through a non- confrontational “helping conversation” (HC) that encourages quitting and use of evidence-based cessation aids (e.g. quitlines, cessation medications) without confrontation and nagging. Our pilot feasibility study of Helpers SQ (N=104) with abstainers from Arizona’s state quitline compared 30-day abstinence at 7-months with a propensity score matched sample from quitline clients not exposed to Helpers SQ. Preliminary results: Helpers SQ participants reported higher 30-day abstinence than non-participants (82% vs. 36%, Difference = 46% [95% CI: 37%, 56%, p<0.0001]). Encouraged by these results, we hypothesize that quitline abstainers exposed to Helpers SQ will have higher 30-day and 7-day point prevalence abstinence than those receiving quitline follow-up usual care, and that the effect of Helpers SQ may be mediated by PN characteristics. To test this hypothesis, we propose a pragmatic randomized controlled trial (N=940) with embedded mixed-methods PN study to assess the effect of Helpers SQ training on proportion and duration of abstainers’ abstinence over time, and on abstainer’s PN interactions related to smoking and smoking cessation. Metrics derived from the PN study will be used for mediational analyses of overall, and gender-based effects of Helpers SQ on smoking relapse.