A Multi-Media Approach to Partner Support in Smokeless Tobacco Cessation

描述（由申请人提供）：合作伙伴支持无烟烟草戒烟无烟烟草的使用继续以每年至少4%的速度增长，并构成重大健康风险。需要新的方法来扩大性传播疾病戒烟计划的覆盖面，使之覆盖到不自行寻求治疗的性传播疾病使用者。本提案的目标是评估一种创新方法，通过争取其妻子/伴侣的支持来鼓励男性性传播感染使用者戒烟，既引导性传播感染使用者参与治疗，又帮助他们保持禁欲。我们提出的干预是基于响应性理论的，该理论表明，如果支持传达了验证（尊重ST使用者的决定和自主权）、理解（ST使用者对戒烟的矛盾心理和戒烟过程的挑战）和关怀（耐心、温暖和对ST使用者福祉的关注），那么支持将获得最好的效果。干预将通过两种方式提供信息：印刷指南、展示指南信息的交互式网站以及定制的交互式支持计划、模拟支持行为的视频，以及允许参与者与彼此和项目工作人员互动的论坛。这种多媒体方法旨在吸引在学习方式、获取材料的首选模式（即，在纸上或在网上）和互联网接入方面可能有所不同的妇女。在之前的可行性研究（R21-CA131461）中，我们创建了指南的初始版本，并确定女性可以很容易地招募到干预来帮助她们的伴侣戒烟。我们现在建议进行一项双臂随机临床试验，将干预与延迟治疗对照进行比较，在最终评估后访问干预网站和印刷指南。主要结局将是伴侣在7.5个月随访时报告的ST使用者6个月的戒烟情况；次要结果包括ST使用者的戒烟尝试和伴侣支持行为的改变，作为干预的功能。我们将检验伴侣支持行为改变对ST使用者戒烟的中介模型。拟议的研究在两个方面是创新的：(1)目标人群-通过招募性传播感染使用者的妻子/伴侣，我们将鼓励那些不寻求治疗的性传播感染使用者戒烟，包括那些戒烟准备程度较低的人，以及(2)干预的理论基础。如果拟议的目标得以实现，我们将建立一种方法，可以扩大现有性传播疾病戒烟计划的覆盖面和有效性。该方法可以推广到戒烟干预和其他健康行为改变干预。

DESCRIPTION (provided by applicant): Partner Support in Smokeless Tobacco Cessation Smokeless tobacco (ST) use continues to grow by at least 4% annually, and poses significant health risks. New methods are needed to expand the reach of ST cessation programs to ST users who do not seek treatment on their own. The goal of this proposal is to evaluate an innovative approach that encourages male ST users to quit by enlisting the support of their wives/ partners, both to lead the ST users to engage in treatment and to help them sustain abstinence. Our proposed intervention is based on responsiveness theory, which indicates that support will be received best if it conveys validation (respect for the ST user's decisions and autonomy), understanding (of the ST user's ambivalence about quitting and of the challenges of the cessation process), and caring (patience, warmth, and concern about the ST user's well-being). The intervention will present information via two modalities: a printed guidebook, and an interactive website presenting the guidebook information along with an interactive tailored support plan, videos modeling supportive behavior, and forums allowing participants to interact with each other and project staff. This multi- media approach is intended to appeal to women who may vary in learning styles, preferred mode of access to materials (i.e., in paper or on the web), and Internet access. In a previous feasibility study (R21-CA131461), we created an initial version of the guidebook and established that women can be readily recruited to an intervention to help their partners quit ST. We now propose to conduct a two-armed randomized clinical trial, comparing the intervention with a delayed treatment control giving access to the intervention website and printed guidebook after the final assessment. The primary outcome will be the ST user's 6-month cessation as reported at 7.5-month follow-up by the partner; secondary outcomes include ST users' quit attempts and change in the partner's supportive behaviors as a function of the intervention. We will test a mediating model relating change in partner's supportive behaviors to the ST user's cessation. The proposed study is innovative in two ways: (1) the target population - by recruiting the wives/partners of ST users, we will be encouraging cessation among ST users who are not themselves seeking treatment, including those at lower levels of readiness to quit, and (2) the theoretical basis for the intervention. If the proposed ais are achieved, we will have established a method that can expand the reach and effectiveness of existing ST cessation programs. The approach could be generalized to smoking cessation interventions and to other health behavior change interventions.