Effects of Message Framing on Cessation among Couples where both Partners Smoke

描述（由申请人提供）：夫妻双方成员吸烟代表戒烟干预的关键目标。在这些人中，戒烟率较低，复发率较高，每个人的健康风险由于暴露于伴侣的吸烟而被放大。作为一种促进戒烟的策略，尽管有这些事实，但信息框架干预措施并没有强调吸烟与健康、外表和经济状况相关的结果如何共同影响夫妻双方。对于双方都吸烟的夫妇，干预信息可以突出戒烟的积极结果（即，积极框架）或不退出的成本（即，消极框架）影响个人吸烟者或夫妇。本研究扩展了先前的框架研究，通过研究如何获得与损失框架的信息集中在个人与夫妇水平的结果影响（a）信息接受，可操作的信息准确性，可信度和结果相关性的评估;（B）可能的调解人成功戒烟在个人和关系水平， 包括意图，风险认知，自我和二元功效，和共同应对操作的自我报告和第一人称复数代词使用（我们谈）在一对夫妇的谈话戒烟;和（c）吸烟行为的变化超过6个月，验证生化。参与者将是120对夫妇（已婚或已婚，同性和异性），其中双方都吸烟，并且在未来30天内都不打算戒烟。我们将在2 x 2析因设计中将耦合随机分配到4个单元中的1个，该设计跨越增益与损耗框架， 关注自我与伴侣的结果。具体的干预操作将通过书面叙述、关键框架点总结和初次干预后1周提供的增强信息来实施和加强。除了随机分组前的基线评估外，夫妇将立即完成一项干预后调查，评估信息接受程度以及假设的个人和关系中介;参加一项关于吸烟的联合干预后访谈（通过自动文本分析，转录后会产生“我们谈话”）;并在1个月和6个月后提供随访数据，以评估戒烟意图、吸烟量和戒烟等结果。我们假设：（a）以夫妇为中心的框架信息，而不是个人层面的结果，将更有效地激励戒烟;（B）收益框架信息将比损失框架信息更有说服力，特别是当信息结果的焦点是夫妇时;（c）以夫妇为中心的信息将最有效地促进假设的关系变化机制，如二元效能和社区应对;以及（d）在关系质量高的夫妇中，所有这些关联都更强。如果结果为这些新的和未经调查的假设提供了初步支持，则将使用效应量估计来提出更大的随机试验。当高风险目标群体是双方都吸烟的夫妇时，这项研究应该为信息框架在临床实践和公共卫生中的新应用提供重要的战略见解。

DESCRIPTION (provided by applicant): Couples in which both members smoke represent key targets for smoking cessation interventions. Quit rates are lower and relapse rates are higher among these individuals, and each person's health risks are amplified due to exposure to their partner's smoking. As a strategy to promote quit, and despite these facts, message framing interventions have not highlighted how smoking outcomes related to health, appearance and finances might affect both partners in a couple jointly. For couples in which both partners smoke, intervention messages can highlight how positive outcomes of quitting (i.e., positive frame) or costs of not quitting (i.e., negative frame) affect the individual smoker or the couple. This study extends prior framing research by examining how gain- versus loss-framed messages focused on individual- versus couple-level outcomes influence (a) message acceptance, operationalized by evaluations of message accuracy, credibility and outcome relevance; (b) likely mediators of successful cessation at both individual and relationship levels, including intentions, risk perceptions, self- and dyadic efficacy, and communal coping operationalized both by self-report and first person plural pronoun use (we-talk) in a couple conversation about quitting; and (c) smoking behavior change over 6 months, verified biochemically. Participants will be 120 couples (married or living as married, same and opposite sex) in which both members smoke and neither plans to quit during the next 30 days. We will randomize couples to 1 of 4 cells in a 2 x 2 factorial design that crosses gain vs. loss frame with self vs. couple outcomes focus. The specific intervention manipulations will be implemented and reinforced via written narratives, summaries of key framing points, and booster messages given 1 week after the initial intervention session. In addition to a baseline assessment before randomization, couples will complete an immediate post-intervention survey assessing message acceptance plus hypothesized individual and relational mediators; participate in a joint post-intervention interview about smoking (with transcripts later yielding "we-talk" via automatic text analysis); and provide follow-up data 1 and 6 months later to assess outcomes such as intentions to quit, amount smoked, and cessation. We hypothesize that (a) framed messages focused on couple- rather than individual-level outcomes will be more effective in motivating quitting; (b) gain-framed messages will be more persuasive than loss-framed messages, especially when the message outcome focus is the couple; (c) couple-focused messages will be most effective in prompting hypothesized relational change mechanisms such as dyadic efficacy and communal coping; and (d) all these associations will be stronger in couples with high relationship quality. If results provide preliminary support for these novel and uninvestigated hypotheses, effect size estimates will be used to propose a larger randomized trial. This research should add important strategic insights to new applications of message framing in clinical practice and public health when the high-risk target group is couples in which both partners smoke.