Elective Surgery as a Teachable Moment for Smoking Cessation

描述（由申请人提供）：“教育时刻”是指激励个人自发采取降低风险的健康行为的事件。诸如诊断出与吸烟有关的疾病（如癌症）和自发安排手术（即在没有干预措施的情况下）等事件可增加戒烟率。然而，正如麦克布莱德等人最近在一篇重要的概念性论文中所讨论的那样，人们对使某些提示事件“可教”的因素知之甚少。他们提出了一种启发式方法，其中一个事件是戒烟的“教育时刻”，其影响程度为3个关键构念。虽然在概念上很有吸引力，但其有效性尚未得到评价。手术安排为检验麦克布莱德模型提供了一个独特的机会。本研究将评估麦克布莱德启发式在选择性外科手术后吸烟行为的应用。将追求两个具体目标。首先，我们将开发针对手术环境的Me Bride模型的措施，并在一组手术患者中对其稳定性和内部一致性进行初步评估。在第二部分，我们将进行一项试点研究，以探索以下假设：在计划进行选择性手术的患者中：1)对与吸烟相关的健康结果有更高的风险认知或更大的负面预期，2)更高水平的积极或消极情感反应，以及3)与吸烟相关的自我概念或角色预期将与自我效能感和意图的测量相关，并预测术后戒烟。麦克布莱德结构的测量将被用于计划进行择期手术的吸烟者，其吸烟行为将在术后30天内进行评估。结构方程建模将用于验证Aim 1中建立的测量模型，并检验与McBride启发式相关的结构模型对术后吸烟行为的拟合性。与公共卫生相关：对麦克布莱德启发式的评估不仅从理论角度来看是有趣的，而且可能对设计利用“可教时刻”的行为干预具有实际意义。例如，如果构念预测行为，干预可以尝试具体影响这些构念。我们的总体目标是为外科患者制定有效的烟草使用干预措施；这个项目将是这一进程中的重要一步。

DESCRIPTION (provided by applicant): The term "teachable moment" refers to an event that motivates individuals to spontaneously adopt risk- reducing health behaviors. Events such as the diagnosis of smoking-related illnesses (e.g. cancer) and the scheduling of surgery spontaneously (i.e., in the absence of interventions) increase the rate of quitting. However, as recently discussed in an important conceptual paper by McBride et al, little is known about factors that make certain cueing events "teachable". They proposed a heuristic in which an event is a "teachable moment" for smoking cessation to the extent that it impacts 3 key constructs. Although appealing in concept, its validity has not been evaluated. The scheduling of surgery provides a unique opportunity to test the McBride model. This study will evaluate the McBride heuristic as applied to smoking behavior following elective surgical procedures. Two specific aims will be pursued. In the first we will develop measures of the Me Bride model specific to the surgical setting, and perform an initial evaluation of their stability and internal consistency in a group of surgical patients. In the second, we will perform a pilot study to explore the hypothesis that in patients scheduled for elective surgery: 1) higher perceptions of risks or greater negative expectancies regarding health outcomes related to smoking, 2) higher levels of positive or negative affective responses, and 3) self-concept or role expectations related to smoking will correlate with measures of self-efficacy and intent, and predict postoperative abstinence from smoking. Measures of the McBride constructs will be administered to smokers scheduled for elective surgery, whose smoking behavior will be evaluated for up to 30 days postoperatively. Structural equation modeling will be utilized both to validate the measurement model established in Aim 1 and to test the fit of the structural model associated with the McBride heuristic to postoperative smoking behavior. Relevance to public health: Evaluation of the McBride heuristic is of interest not only from a theoretical standpoint, but may have practical implications regarding the design of behavioral interventions to exploit the "teachable moment. For example, if the constructs predict behavior, interventions can attempt to specifically influence these constructs. Our overall goal is to develop effective tobacco use interventions for surgical patients; this project will be an important step in this process.