Effect of Helpers Program On-line Training on Smoking Relapse and Social Networks

摘要 尽管戒烟治疗取得了重大进展，但超过一半的最近戒烟的吸烟者将在2015年内复发。 第一年两项复发预防研究的系统评价得出了不同的有效性结论 行为干预。预防复发的现有证据受到研究设计、方法学 和行为干预的概念方法。复发预防研究的不同方法， 和干预措施本身，以促进长期的理解和成果， 预防吸烟复发。到目前为止，复发预防干预措施的重点是新近戒烟者， 吸烟者（“戒烟者”），并且不试图直接或间接影响戒烟者的个人网络 (PN)例如，通过帮助戒酒者影响PN中的其他人戒烟。个人网络发挥着强大的 对启动和维持吸烟行为的影响，并有助于维持戒烟或触发 复发一种“帮助他人”的干预措施，旨在提高戒烟者影响吸烟者的能力， PN戒烟-从而创造一个PN社会环境更支持长期禁欲-可能有一个 对复发有积极作用。Helpers SQ的干预措施鼓励戒酒者加强自己的 通过帮助他人戒烟来戒烟，并积极影响他们的PN，使其更有利于长期 戒烟。将复发视为一个动态和复杂的过程，帮助者保持退出（帮助者SQ） 干预是一种概念新颖的预防复发的方法，它整合了不同的行为理论 转化为一个多方面的干预模式，作为一个在线戒烟简短的干预培训。 Helpers SQ教导戒烟者如何鼓励其他烟草使用者戒烟，避免复吸， 对抗性的“帮助对话”（HC），鼓励戒烟和使用循证戒烟辅助工具 (e.g.戒烟热线，戒烟药物）没有对抗和唠叨。我们的试验性可行性研究 SQ（N=104）与来自亚利桑那州戒烟热线的戒烟者进行了比较， 倾向评分匹配样本来自未接触Helpers SQ的退出线客户。初步结果：助手 SQ参与者报告的30天禁欲率高于非参与者（82% vs. 36%，差异= 46% [95% CI：37%，56%，p<0.0001]）。受这些结果的鼓舞，我们假设戒烟者暴露于 与接受戒烟线的受试者相比， 随访常规护理，辅助SQ的效果可能由PN特征介导。为了验证这一 假设，我们提出了一个实用的随机对照试验（N=940）与嵌入式混合方法PN 研究旨在评估帮工SQ培训对戒烟者戒烟比例和持续时间的影响， 时间，以及戒烟者与吸烟和戒烟相关的PN相互作用。来源于 PN研究将用于对Helpers SQ对吸烟的总体和基于性别的影响进行中期分析 复发

Abstract Despite major gains in smoking cessation treatment, over half of recently quit smokers will relapse within the first year. Two systematic reviews of relapse prevention studies came to different conclusions on effectiveness of behavioral interventions. Existing evidence in relapse prevention is limited by study designs, methodology, and conceptual approaches to behavioral interventions. Different approaches to relapse prevention studies, and to the interventions themselves are needed to advance the long-term understanding and outcomes of smoking relapse prevention. To date, relapse prevention interventions have focused on the newly abstinent smoker (“abstainer”), and not attempted to directly or indirectly influence the abstainer’s personal network (PN), e.g. by helping the abstainer influence others in their PN to quit. Personal networks exert powerful effects on initiating and maintaining smoking behavior, and can facilitate maintaining abstinence or trigger relapse. A “help others” intervention that seeks to increase the abstainer’s ability to influence smokers in their PN to quit – thereby creating a PN social environment more supportive of long-term abstinence - may have a beneficial effect on relapse. The Helpers SQ intervention encourages abstainers to reinforce their own abstinence through helping others quit, and to proactively influence their PN to be more conducive to long-term smoking abstinence. Framing relapse as a dynamic and complex process, the Helpers Stay Quit (Helpers SQ) intervention is a conceptually novel approach to relapse prevention that integrates different behavioral theories into a multifaceted intervention model presented as an on-line tobacco cessation brief intervention training. Helpers SQ teaches abstainers how to encourage other tobacco users to quit and avoid relapse through a non- confrontational “helping conversation” (HC) that encourages quitting and use of evidence-based cessation aids (e.g. quitlines, cessation medications) without confrontation and nagging. Our pilot feasibility study of Helpers SQ (N=104) with abstainers from Arizona’s state quitline compared 30-day abstinence at 7-months with a propensity score matched sample from quitline clients not exposed to Helpers SQ. Preliminary results: Helpers SQ participants reported higher 30-day abstinence than non-participants (82% vs. 36%, Difference = 46% [95% CI: 37%, 56%, p<0.0001]). Encouraged by these results, we hypothesize that quitline abstainers exposed to Helpers SQ will have higher 30-day and 7-day point prevalence abstinence than those receiving quitline follow-up usual care, and that the effect of Helpers SQ may be mediated by PN characteristics. To test this hypothesis, we propose a pragmatic randomized controlled trial (N=940) with embedded mixed-methods PN study to assess the effect of Helpers SQ training on proportion and duration of abstainers’ abstinence over time, and on abstainer’s PN interactions related to smoking and smoking cessation. Metrics derived from the PN study will be used for mediational analyses of overall, and gender-based effects of Helpers SQ on smoking relapse.