Can Motivational Interviewing be Effective for Smoking Cessation?

吸烟仍然是美国最重要的可预防的死亡原因之一，尽管大多数吸烟者对戒烟感兴趣，但只有五分之一的人准备在任何时候尝试戒烟。不幸的是，很少有干预措施，旨在提高动机或准备吸烟者谁不准备戒烟。一种着重于增强行为改变的动机和承诺的干预方法是动机性访谈（MI）。MI已被证明可以有效地解决各种成瘾和健康行为，但戒烟的结果绝大多数是负面的，所有先前的研究都有显着的局限性。先前研究的一个重要局限性是，它们的目的不是直接测试MI是否对不准备戒烟的吸烟者更有效，特别是MI是否更有效地激励戒烟尝试。此外，几乎所有的研究都集中在特殊人群，如公共住房居民、青少年和精神疾病患者，其中许多人在戒烟时面临严重的环境和生理障碍。因此，本研究的主要目的是在一般成年吸烟者样本中测试MI在尚未准备好戒烟的吸烟者中激励戒烟尝试的有效性。我们将随机分配符合条件的吸烟者动机访谈（MI），PHS指南为基础的咨询控制（GBC），或简短的建议（BA）。主要结局将是随机化和6个月随访之间发生（或未发生）任何持续至少24小时的自我报告的戒烟尝试。次要目的是检查组间6个月随访戒烟率，以提供可用于设计主要结局为戒烟的大规模研究的效应量估计值。BA的参与者将接受1次会议，MI和GBC的参与者将在7周内接受5次单独会议（2次面对面，3次电话）。所有决定退出的受试者将获得伐尼克兰（Chantix）。我们计划需要招募255名未准备戒烟的吸烟者，以检测拟议的治疗效果。公共卫生相关性：吸烟仍然是美国最重要的可预防的死亡原因之一，尽管大多数吸烟者有兴趣戒烟，但五分之四的人在任何给定的时间点都没有准备好戒烟。这个项目通过测试一种被称为动机访谈的新的咨询方法来解决缺乏旨在提高戒烟准备的方法的问题。潜在的公共卫生影响是巨大的，因为它可以将有效的戒烟干预措施扩展到大多数没有动机的吸烟者，并减少吸烟开始和戒烟之间长达数十年的滞后。

DESCRIPTION (provided by applicant): Tobacco smoking remains one of the most significant preventable causes of death in the U.S. Although most smokers are interested in quitting, only one in five are ready to make a quit attempt at any point in time. Unfortunately, few interventions designed to enhance motivation or readiness among smokers who are not ready to quit are available. One intervention method that focuses on enhancing motivation for and commitment to behavior change is Motivational Interviewing (MI). MI has been shown to be effective for addressing a variety of addictive and health behaviors, however findings for smoking cessation have been overwhelmingly negative and all prior studies have significant limitations. One important limitation of prior studies is that they were not designed to directly test whether MI is more effective for smokers who are not ready to quit, and in particular, whether MI was more effective at motivating quit attempts. Moreover, nearly all focused on special populations such as public housing residents, adolescents, and people with mental illness, many of whom face significant environmental and physiological barriers to quitting. Therefore, the primary aim of this study is to test, among a sample of general adult smokers, the effectiveness of MI for motivating quit attempts among smokers not yet ready to quit. We will randomly assign eligible smokers to Motivational Interviewing (MI), a PHS Guidelines-based counseling control (GBC), or brief advice (BA). The primary outcome will be the occurrence (or not) of any self-reported quit attempt lasting at least 24 hours between randomization and 6 month follow-up. The secondary aim will be to examine 6 month follow-up quit rates between the groups in order to provide an effect size estimate that could be used in designing a large scale study with a primary outcome of smoking cessation. Participants in BA will receive 1 session and participants MI and GBC will receive 5 individual sessions (2 in-person, 3 phone) over 7 weeks. All participants who decide to quit will be provided with varenicline (Chantix). We project needing to enroll 255 smokers who are not ready to quit to detect the proposed treatment effect. PUBLIC HEALTH RELEVANCE: Tobacco smoking remains one of the most significant preventable causes of death in the U.S. and although most smokers are interested in quitting, four in five are not ready to make a quit attempt at any given point in time. This project addresses the lack of methods designed to increase readiness to quit by testing a novel counseling method known as Motivational Interviewing. The potential public health impact is large because it could extend the reach of effective cessation interventions to the majority of smokers who are unmotivated and reduce the decades-long lag between smoking initiation and cessation.