Optimizing an online motivational tobacco cessation program

描述（由申请人提供）：在美国，吸烟是导致死亡和残疾的主要原因。尽管如此，21%的美国成年人继续定期吸烟，不到20%的人准备戒烟或随时采取行动戒烟。换句话说，大约80%或更多的吸烟者没有足够的动力和准备戒烟，即使他们可能有一天想戒烟。目前迫切需要干预措施，以便能够接触到这些人，增强他们戒烟的动机，促进采用现有的经经验验证的治疗方法，并最终提高人口水平的戒断率。通过互联网提供的动机干预可以很容易地根据个别吸烟者的需要进行调整。现在有大量的研究表明，计算机定制的健康行为改变干预措施可能比一般干预措施更有效，特别是对于戒烟，但在定制在线动机干预措施时，不太清楚哪些具体内容和表现因素最有效，以及对谁最有效。目前的研究将测试五个潜在重要的裁剪因素（决策框架、信息框架、自我效能、导航自主性和主动外展）的有效性。动机访谈原则、社会认知理论、前景理论和跨理论模型在很大程度上影响了因素选择。除了检查每个因素对治疗结果是否重要外，我们还将通过探索可能调节或缓和结果的相关个体特征的影响来检查每个因素对谁最重要。这种程度的理解对于设计未来量身定制的课程非常重要。本研究的参与者将从美国一个大型区域性健康计划中招募。使用分数析因设计筛选重要的主效应和双向相互作用，参与者将被随机分配接受16种不同实验因素组合中的一种，并随访一年，以评估项目对吸烟者戒烟动机、使用经经验验证的戒烟治疗和戒烟的影响。拟议的研究是我们合作团队在定制，开发戒烟动机和行动导向计划，健康风险沟通研究以及创建在线健康行为改变计划方面工作的自然延伸。从这项研究中获得的信息将推动量身定制健康风险沟通的科学，并告知如何最好地设计戒烟的在线动机干预。这是我们所知的第一个解决这一重要问题的研究。公共卫生相关性：减少美国的吸烟率需要动机干预，这种干预既能有效地促进戒烟，又能很容易地在人口水平上传播。通过Internet提供的计算机定制程序在这方面具有很大的潜力，但是这一领域的研究必须超越简单地比较定制和非定制程序，并开始明确哪些内容和呈现因素可以提高定制效果，以及为谁提供。这项提议的研究是我们所知道的第一个在戒烟的在线动机干预的背景下研究这个问题的研究。从这项研究中获得的信息将推动量身定制健康风险沟通的科学，并告知如何最好地设计戒烟的在线动机干预。

DESCRIPTION (provided by applicant): Smoking is the leading cause of death and disability in the U.S. Despite this, 21% of U.S. adults continue to smoke on a regular basis and less than about 20% are ready to quit smoking or taking action to quit at any given time. In other words, about 80% or more of smokers are not sufficiently motivated and ready to quit smoking, even though they may want to quit someday. Interventions are critically needed which can reach these people, enhance their motivation for quitting, promote uptake of existing empirically-validated treatments, and ultimately enhance abstinence rates on a population level. Motivational interventions delivered via the Internet can be easily tailored to the needs of individual smokers. There is now a large body of research demonstrating that computer-tailored health behavior change interventions can be more effective than generic interventions, particularly for smoking cessation, but it is less clear what specific content and presentation factors will be most effective and for whom when tailoring an online motivational intervention. The current study will test the effectiveness of five potentially important tailoring factors (decisional framework, message framing, self-efficacy, navigation autonomy, and proactive outreach). Factor choice was largely informed by the principles of Motivational Interviewing, Social Cognitive Theory, Prospect Theory, and the Transtheoretical Model. In addition to examining whether each factor is important for treatment outcome, we will also examine for whom each factor is most important by exploring the influence of relevant individual characteristics which may mediate or moderate outcomes. This level of understanding is important for designing future tailored programs. Participants in this study will be recruited from a large, regional U.S. health plan. Using a fractional factorial design to screen for important main effects and 2-way interactions, participants will be randomized to receive one of 16 different experimental factor combinations and followed for one year to assess program impact on smokers' motivation for quitting, use of empirically-validated cessation treatment, and abstinence. The proposed research is a natural extension of our collaborative team's work in tailoring, developing motivational and action oriented programs for smoking cessation, health risk communications research, and creating online health behavior change programs. Information learned from this study will advance the science of tailoring health risk communications, as well as inform how to best design an online motivational intervention for smoking cessation. This is the first study we are aware of to address this important issue. PUBLIC HEALTH RELEVANCE: Reducing smoking prevalence in the U.S. will require motivational interventions which are both effective at promoting abstinence and can be easily disseminated on a population level. Computer-tailored programs delivered over the Internet hold great potential for this purpose, but research in this area must move beyond simply comparing tailored to non-tailored programs and begin to specify which content and presentation factors enhance tailoring effectiveness and for whom. The proposed study is the first we are aware of to examine this issue in the context of an online motivational intervention for smoking cessation. Information learned from this study will advance the science of tailoring health risk communications, as well as inform how to best design an online motivational intervention for smoking cessation.