Optimizing an online motivational tobacco cessation program

描述(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%的美国成年人仍然经常吸烟，随时准备戒烟或采取行动戒烟的人不到20%。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。迫切需要能够接触到这些人的干预措施，增强他们戒烟的动机，促进对现有经验验证的治疗的接受，并最终在人口层面上提高禁酒率。通过互联网提供的激励性干预措施可以很容易地适应个人吸烟者的需要。现在有大量研究表明，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，特别是在戒烟方面，但在定制在线动机干预措施时，哪些具体内容和呈现因素最有效，对谁最有效，目前还不太清楚。目前的研究将测试五个潜在的重要定制因素(决策框架、消息框架、自我效能、导航自主性和主动外联)的有效性。动机访谈理论、社会认知理论、前景理论和跨理论模型在很大程度上决定了因素选择。除了检查每个因素是否对治疗结果重要外，我们还将通过探索可能中介或适度结果的相关个人特征的影响，来检查每个因素对谁最重要。这一水平的理解对于设计未来的定制程序非常重要。这项研究的参与者将从一个大型的地区性美国健康计划中招募。使用部分析因设计来筛选重要的主效应和双向交互作用，参与者将被随机接受16个不同实验因素组合中的一个，并跟踪一年，以评估计划对吸烟者戒烟动机、经验验证的戒烟治疗和戒烟的使用的影响。这项拟议的研究是我们合作团队在为戒烟、健康风险沟通研究和创建在线健康行为改变计划量身定做、开发激励性和行动导向计划方面工作的自然延伸。从这项研究中获得的信息将促进定制健康风险沟通的科学，以及如何最好地设计在线戒烟动机干预措施。这是我们意识到的第一项解决这一重要问题的研究。与公共健康相关：降低美国的吸烟率将需要激励性干预措施，这些干预措施既能有效地促进戒烟，又能在人群水平上很容易传播。通过互联网提供的计算机定制节目具有巨大的潜力，但这一领域的研究必须超越简单地将定制节目与非定制节目进行比较，并开始具体说明哪些内容和呈现因素增强了定制的有效性和针对谁。这项拟议的研究是我们所知道的第一个在在线戒烟动机干预的背景下检查这一问题的研究。从这项研究中获得的信息将促进定制健康风险沟通的科学，以及如何最好地设计在线戒烟动机干预措施。

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.