A Multi-Media Approach to Partner Support in Smokeless Tobacco Cessation

描述(由申请人提供)：合作伙伴在无烟烟草戒烟方面的支持无烟烟草(ST)的使用持续以每年至少4%的速度增长，并构成重大的健康风险。需要新的方法将ST戒烟计划的覆盖范围扩大到不自行寻求治疗的ST使用者。这项提议的目标是评估一种鼓励男性性交使用者戒烟的创新方法，即争取其妻子/伴侣的支持，以引导性行为使用者进行治疗并帮助他们维持戒毒。我们建议的干预基于响应性理论，该理论表明，如果支持传达了确认(尊重ST用户的决定和自主性)、理解(ST用户对戒烟和戒烟过程中的挑战的矛盾心理)和关怀(耐心、热情和对ST用户福祉的关注)，那么支持将得到最好的接收。干预将通过两种方式提供信息：印刷的指南，以及展示指南信息的互动网站，以及互动的定制支持计划、模拟支持性行为的视频，以及允许参与者彼此互动和项目工作人员互动的论坛。这一多媒体方法的目的是吸引学习风格、获取材料的首选方式(即纸质或网络)和互联网接入方面可能不同的妇女。在之前的可行性研究中(R21-CA131461)，我们创建了指南的初始版本，并确定可以很容易地招募女性参与帮助她们的伴侣戒除ST的干预。我们现在建议进行一项双臂随机临床试验，将干预与延迟治疗对照进行比较，以便在最终评估后访问干预网站和印刷指南。主要结果将是ST使用者在7.5个月的随访中报告的6个月的戒烟；次要结果包括ST使用者的戒烟尝试和作为干预功能的伴侣的支持行为的变化。我们将测试一个中介模型，将伴侣支持行为的变化与ST使用者的戒烟联系起来。拟议的研究在两个方面具有创新性：(1)目标人群--通过招募ST使用者的妻子/伴侣，我们将鼓励本身没有寻求治疗的ST使用者戒烟，包括那些戒烟意愿较低的人，以及(2)干预的理论基础。如果拟议的人工智能得以实现，我们将建立一种方法，可以扩大现有ST戒断计划的覆盖范围和有效性。该方法可以推广到戒烟干预和其他健康行为改变干预。

DESCRIPTION (provided by applicant): Partner Support in Smokeless Tobacco Cessation Smokeless tobacco (ST) use continues to grow by at least 4% annually, and poses significant health risks. New methods are needed to expand the reach of ST cessation programs to ST users who do not seek treatment on their own. The goal of this proposal is to evaluate an innovative approach that encourages male ST users to quit by enlisting the support of their wives/ partners, both to lead the ST users to engage in treatment and to help them sustain abstinence. Our proposed intervention is based on responsiveness theory, which indicates that support will be received best if it conveys validation (respect for the ST user's decisions and autonomy), understanding (of the ST user's ambivalence about quitting and of the challenges of the cessation process), and caring (patience, warmth, and concern about the ST user's well-being). The intervention will present information via two modalities: a printed guidebook, and an interactive website presenting the guidebook information along with an interactive tailored support plan, videos modeling supportive behavior, and forums allowing participants to interact with each other and project staff. This multi- media approach is intended to appeal to women who may vary in learning styles, preferred mode of access to materials (i.e., in paper or on the web), and Internet access. In a previous feasibility study (R21-CA131461), we created an initial version of the guidebook and established that women can be readily recruited to an intervention to help their partners quit ST. We now propose to conduct a two-armed randomized clinical trial, comparing the intervention with a delayed treatment control giving access to the intervention website and printed guidebook after the final assessment. The primary outcome will be the ST user's 6-month cessation as reported at 7.5-month follow-up by the partner; secondary outcomes include ST users' quit attempts and change in the partner's supportive behaviors as a function of the intervention. We will test a mediating model relating change in partner's supportive behaviors to the ST user's cessation. The proposed study is innovative in two ways: (1) the target population - by recruiting the wives/partners of ST users, we will be encouraging cessation among ST users who are not themselves seeking treatment, including those at lower levels of readiness to quit, and (2) the theoretical basis for the intervention. If the proposed ais are achieved, we will have established a method that can expand the reach and effectiveness of existing ST cessation programs. The approach could be generalized to smoking cessation interventions and to other health behavior change interventions.