Real-time Assessment of Autonomy in Smoking Cessation

描述（由申请人提供）：本项目将在NCI资助的烟草依赖随机对照试验（RCT）的前5周治疗期间，将一种新方法（间隔-视情况抽样程序-ICSP）与标准问卷进行比较，以评估自我决定理论（SDT）过程变量，即自主支持和自主戒烟动机以及自主使用药物。这项随机对照试验建立在我们之前对吸烟者进行强化治疗的随机对照试验的基础上，新的试验将在12个月和24个月时检查经过生化验证的长期烟草使用结果。拟议的研究将包含在新的试验中，将检查动机变量的评估，以便将ICSP数据评估与问卷评估在预测短期禁欲结果方面进行比较。先前的研究结果表明，密集的SDT为基础的干预显着增加验证的戒烟率（相比社区护理），并介导的效果是增加感知的自主性支持和自主动机。然而，动机变量的影响大小是小到中等。我们期望ICSP评估将提供更可靠的测量，这将增加效应量，并允许更精确地检查基于SDT的干预的具体方面如何产生自主动机的变化。使用ICSP评估，我们将检查在新试验的前5周治疗期间感知的自主支持和自主动机的日常变化，并确定是否每天的禁欲变化导致自主，或者每天的自主变化是否导致禁欲。主要结果将是组间自主戒烟动机和药物治疗的变化。次要结果将包括探索戒烟和使用药物的自主动机的个体差异及其与复吸的关系。这将使我们能够在戒烟尝试后的最初几周内更好地了解复发。它还将使我们能够更准确地研究在治疗开始时不准备戒烟的吸烟者如何变得更有动力戒烟，并表现出比可比的社区护理患者更大的戒烟效果，正如我们之前发现的那样。此外，在新的试验中，我们将使用带有电子传感器的药丸瓶盖来检查对戒烟药物的依从性（例如，尼古丁替代品，安非他酮），我们也希望，根据我们以前的试验，这是一个重要的戒烟途径，并通过自主支持和自主动机来促进。我们预计，ICSP评估的动机变量将提供更好的预测服药依从性和禁欲。拟议的研究对公共卫生的潜在好处是更清楚地了解如何激励戒烟，从而降低心血管疾病、癌症和肺气肿这三个主要原因的死亡率。该项目将比较一种新的方法（间隔-视情况抽样程序），在烟草依赖治疗的前5周内，每天询问人们关于吸烟的情况，以评估他们戒烟和使用药物的动机。我们预期，间隔-条件抽样程序评估的动机变量将提供更好的预测药物使用和戒烟。拟议的研究对公共卫生的潜在好处是更清楚地了解如何激励戒烟，从而降低心血管疾病、癌症和肺气肿这三个主要原因的死亡率。

DESCRIPTION (provided by applicant): This project will compare a new methodology (Interval-Contingent Sampling Procedure-ICSP) to standard questionnaires for assessing the self-determination theory (SDT) process variables, namely autonomy support, and autonomous motivation for cessation and autonomous use of medications, during the first 5 weeks of treatment in an NCI funded tobacco dependence randomized controlled trial (RCT). The RCT builds on the results of our previous RCT of intensive treatment of smokers, and the new trial will examine biochemically validated long-term tobacco use outcomes at 12 and 24 months. The proposed study, to be contained within the new trial, would examine the assessment of motivation variables in order to compare the ICSP data assessments to questionnaire assessments in terms of their prediction of the short term abstinence outcomes. Previous results showed that the intensive SDT-based intervention significantly increased validated cessation rates (compared to community care), and that the effect was mediated by increases in perceived autonomy support and autonomous motivation. However, the effect sizes on the motivation variables were small to moderate. We expect that the ICSP assessments will provide more reliable measurements which will increase the effect sizes and allow the more precise examination of how specific aspects of the SDT-based intervention produce changes in autonomous motivation. Using ICSP assessment we will examine day-to-day changes in perceived autonomy support and autonomous motivation during the first 5 weeks of treatment in the new trial, and determine whether day to day changes in abstinence leads to autonomy, or if day to day change in autonomy leads to abstinence. Primary outcomes will be the change in autonomous motivation for cessation and medications between groups. Secondary outcomes will include exploring within person variation of autonomous motivation for cessation and use of medications and their relation to relapse to smoking. This will allow us to gain a better understanding of relapse during the early weeks after quit attempts. It will also allow us to examine more exactingly how smokers who are not ready to quit at the beginning of treatment became more motivated to quit and show greater cessation than comparable community care patients, as we found previously. Further, in the new trial, we will use pill bottle caps with electronic sensors to examine adherence to cessation medications (e.g., nicotine replacement, bupropion), which we also expect, based on our previous trial, to represent an important path to cessation and to be promoted by autonomy support and autonomous motivation. We anticipate that the ICSP assessment of the motivation variables will provide improved prediction of both medication adherence and abstinence. The potential benefits of the proposed research to public health is to more clearly understand how to motivate tobacco abstinence that will reduce mortality from three leading causes; cardiovascular disease, cancer, and emphysema. This project will compare a new methodology (Interval-Contingent Sampling Procedure) for asking people on a daily basis about their smoking to standard questionnaires for assessing their motivation for cessation and use of medications, during the first 5 weeks of tobacco dependence treatment. We anticipate that the Interval- Contingent Sampling Procedure assessment of the motivation variables will provide improved prediction of both medication use and abstinence from tobacco. The potential benefits of the proposed research to public health is to more clearly understand how to motivate tobacco abstinence that will reduce mortality from three leading causes; cardiovascular disease, cancer, and emphysema.