Reducing Tobacco Related Health Disparities

描述（由申请人提供）：拟议的研究将评估一种基于理论和经验的“动机和解决问题”（MAPS）干预措施的有效性和成本效益，以促进和促进不准备戒烟的低收入吸烟者戒烟。大约90%的吸烟者（超过4100万人）在任何一个时间点都没有准备好戒烟。MAPS是一种促进行为改变的整体动态方法，它利用基于动机访谈（MI）的动机增强和社会认知方法，治疗烟草使用和依赖临床实践指南和社会认知理论。MAPS是为所有吸烟者设计的，无论他们是否准备戒烟或戒烟过程的阶段如何，并且特别针对改变的动机和内在动机，社会认知结构（例如，代理/自我效能），以及与低收入吸烟者特别相关的其他关键因素（例如，压力、家庭问题、财政资源）。由于MAPS包含一种治疗烟草使用的慢性护理型方法，并围绕着一个“健康计划”，解决了低收入人群中普遍存在的许多障碍和担忧，我们认为它特别适合治疗这些吸烟者。 参与者（N = 900）将是在哈里斯县医院区（HCHD）运营的社区健康诊所就诊的吸烟者。HCHD是服务于休斯顿和哈里斯县的安全网公共卫生保健系统，哈里斯县是美国第四大城市和第三大人口县。HCHD只为未投保和投保不足的人服务。所有参与者将被随访两年，并将被随机分配到三组之一：1）标准治疗[ST]，2）MAPS-4或3）MAPS-8。ST将包括一封信，介绍吸烟者到得克萨斯州戒烟热线，和标准的自助材料。ST将总共发生4次（基线、6、12和18个月）。MAPS-4将包括ST加4个积极的MAPS电话咨询会议，为期2年。MAPS-8将包括ST加8个积极的电话咨询会议，为期2年。将在基线时和基线后6、12、18和24个月进行评估。主要结局变量是6、12、18和24个月随访期间以及24个月随访时的戒烟率。次要结局将包括戒烟尝试和德克萨斯戒烟热线的使用。 公共卫生相关性：建议的研究将评估一项以理论和实践为基础的“动机和解决问题”干预措施的成效和成本效益，以促进和协助未准备戒烟的低收入吸烟者戒烟。大约90%的吸烟者（超过4100万人）在任何一个时间点都没有准备好戒烟。

DESCRIPTION (provided by applicant): The proposed study will evaluate the efficacy and cost-effectiveness of a theoretically- and empirically- based "Motivation And Problem Solving" (MAPS) intervention for promoting and facilitating smoking cessation among low income smokers who are not ready to quit. Approximately 90% of current smokers (over 41 million people) are not ready to quit smoking at any one point in time. MAPS is a holistic, dynamic approach to facilitating behavior change that utilizes a combined motivational enhancement and social cognitive approach based on motivational interviewing (MI) the Treating Tobacco Use and Dependence Clinical Practice Guideline, and social cognitive theory. MAPS is designed for all smokers regardless of their readiness to quit or phase of the quitting process, and specifically targets motivation and intrinsic motives for change, social cognitive constructs (e.g., agency/self-efficacy), and other key factors of particular relevance to low income smokers (e.g., stressors, family issues, financial resources). Because MAPS encompasses a chronic care type approach to treating tobacco use and revolves around a "wellness program" that addresses numerous barriers and concerns that are prevalent among low income individuals, we believe it is particularly appropriate for treating such smokers. Participants (N = 900) will be cigarette smokers attending community health clinics operated by the Harris County Hospital District (HCHD). HCHD is the safety net public health care system serving Houston and Harris County, the nation's fourth largest city and third most populous county. HCHD serves only the uninsured and underinsured. All participants will be followed for a period of two years, and will be randomly assigned to one of three groups: 1) Standard Treatment [ST], 2) MAPS-4, or 3) MAPS-8. ST will consist of a letter referring smokers to Texas Quitline, and standard self-help materials. ST will occur a total of 4 times (Baseline, 6, 12, and 18 months). MAPS-4 will consist of ST plus 4 proactive MAPS telephone counseling sessions over a 2- year period. MAPS-8 will consist of ST plus 8 proactive telephone counseling sessions over a 2-year period. Assessments will occur at Baseline and at 6, 12, 18, and 24 months after Baseline. The primary outcome variables are abstinence from tobacco across the 6, 12, 18, and 24-month follow-ups, and at the 24-month follow-up. Secondary outcomes will include quit attempts and use of the Texas Quitline. PUBLIC HEALTH RELEVANCE: The proposed study will evaluate the efficacy and cost-effectiveness of a theoretically- and empirically-based "Motivation And Problem Solving" (MAPS) intervention for promoting and facilitating smoking cessation among low income smokers who are not ready to quit. Approximately 90% of current smokers (over 41 million people) are not ready to quit smoking at any one point in time.