Motivating Smokers with Mobility Impairments to Quit Smoking

描述（由申请人提供）：身体残疾者与其他弱势群体经历着类似的健康差距（例如，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的关注明显较少。虽然已经为其他弱势群体制定了戒烟干预措施，但没有针对身体残疾者的干预措施。借助辅助行走的身体残疾者（行动障碍）的吸烟率（32.5%）高于不需要辅助行走的残疾人（23%）和非残疾人（19.8%）；Brawarsky et al. 2002)。当前研究的目的是：1)开发一系列基于理论的干预dvd，专注于激励行动障碍人士戒烟（即长期使用某种辅助工具，如助行器，手杖，轮椅，支架等）；2)在560名行动障碍吸烟者的随机试验中，测试干预dvd与基于印刷的标准护理的效果。这两组的材料将在四个月的时间里每月邮寄一次，并根据辞职的准备程度分为不同的部分。两组参与者都将获得：a)如果他们准备戒烟，将免费获得尼古丁贴片；b)在邮件之间简短的电话（约5分钟），以评估和鼓励他们观看材料。我们假设随机接受干预dvd的吸烟者在1、6和12个月的随访中比接受基于打印的标准治疗的吸烟者更有可能实现7天和30天的点流行戒烟。干预dvd将以行为激活理论为基础，并解决这一人群中戒烟的具体障碍（压力增加，积极影响减少，抑郁情绪增加，活动限制和自我效能）。我们假设干预将通过行为激活（目标设定和愉快事件）直接或间接地影响这些中介。我们的一系列初步研究支持在行动障碍人群中使用这些介质，并且考虑到这一人群的经济和行动限制，使用dvd作为一种可接受的干预模式。如果有效，我们的DVD干预可能具有高水平的公共卫生和临床意义，因为它可以很容易地通过国家残疾相关组织、独立生活中心网络或医生办公室以低成本传播，并大大改善身体残疾人士的健康和生活质量。本研究具有创新性，因为没有针对这一人群的研究，它将行为激活理论应用于戒烟，并研究了吸烟领域中相对较新的介质（例如，积极影响，行为激活）。公共卫生相关性：没有针对行动不便吸烟者的戒烟干预措施，尽管该人群中有32.5%的人吸烟。目前的研究旨在为行动障碍患者开发基于理论的戒烟干预DVD，并在一项随机试验中测试其与基于印刷的标准治疗相比在增加戒烟方面的功效。

DESCRIPTION (provided by applicant): 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). PUBLIC HEALTH RELEVANCE: No smoking cessation interventions exist that target smokers with mobility impairments, though 32.5% of this population smokes. The current study aims to develop theory-based Intervention DVD's for smoking cessation for people with mobility impairments and test its efficacy for increasing smoking cessation vs. print-based standard care in a randomized trial.