Motivating Smokers with Mobility Impairments to Quit Smoking

摘要 身体残疾者与其他弱势群体（如， 没有保险，获得医疗和预防保健的机会减少，合并症更多），但 对他们的健康促进给予关注。虽然戒烟干预措施已经开发出来， 其他弱势群体中，没有一个是针对身体残疾人的。身体残疾者 （行动障碍）使用辅助行走的人吸烟率（32.5%）高于使用辅助行走的人， 有残疾和不需要帮助的人（23%）和没有残疾的人（19.8%; Brawarsky et al. 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 在有行动障碍的人中激励戒烟（即，长期使用某种类型的 辅助行走，如步行者、手杖、轮椅、支架等）和2）测试干预的有效性 在一项随机试验中，560名有行动障碍的吸烟者接受DVD与基于打印的标准护理。的 两组材料将每月邮寄一次，为期四个月，并分别组织在 根据准备退出的部分。两组受试者都将免费获得a）尼古丁贴片， 他们准备退出，B）在邮件之间进行简短的电话（约5分钟），以评估和鼓励观看 本服务之目的我们假设，随机接受干预DVD的吸烟者将 在1、6和12个月时，更有可能实现7天和30天的点流行率戒烟 与接受基于打印的标准护理的患者相比。干预DVD将基于 行为激活理论，并解决这一人群戒烟的具体障碍（压力增加， 积极情绪减少，抑郁情绪增加，活动限制和自我效能）。我们假设 干预将直接影响这些介质，以及通过行为激活间接影响这些介质。 (goal设置和愉快的事件）。我们的一系列初步研究支持使用这些介质， 行动不便的人和使用DVD作为一种可接受的干预方式， 经济和流动性的限制。如果有效的话，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以低成本传播， 残疾相关组织、独立生活中心网络或医生办公室， 改善身体残疾人的健康和生活质量。这项研究是创新的，因为没有 研究针对这一人群，它将行为激活理论应用于戒烟， 检查了吸烟领域中相对新颖的介质（例如，积极影响，行为激活）。

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).