Cigarette Smoking among Head and Neck Cancer Patients: A Prospective Study

描述（由申请人提供）：头颈部鳞状细胞癌（HNSCC）患者的行为研究是高度优先的。HNSCC的病因与吸烟和饮酒的健康风险行为有关。在诊断时，吸烟和饮酒的患病率估计分别超过80%和65%。在诊断前一年报告吸烟的患者中，约三分之一在完成癌症治疗后继续吸烟。因此，虽然HNSCC诊断可能被认为是一个“可教的时刻”，其中健康行为改变的动机理论上是很高的，但并非所有患者都认为HNSCC诊断是戒烟的充分催化剂。值得注意的是，这是尽管事实上，继续吸烟与不良的临床结果，包括较差的治疗反应和较高的复发风险。研究人员试图确定HNSCC诊断后与吸烟相关的变量，但目前的文献有限。拟议项目的总体目标是增加对最近诊断为HNSCC的患者中促进和阻碍戒烟的因素的了解。具体目标：（1）描述从HNSCC诊断时间到癌症治疗开始后6个月的吸烟轨迹，（2）评估Ajzen计划行为理论（TPB）用于理解HNSCC患者吸烟变化的效用，以及（3）评估抑郁症状和同时饮酒对了解HNSCC患者吸烟变化的独立贡献。将使用前瞻性纵向设计实现上述目标，其中在治疗开始前以及治疗开始后2个月和6个月对120例HNSCC患者进行评估。本研究将纳入男性和女性，预计受试者的人口统计学特征将反映肯塔基州的人口。每次评估时，将通过电话访谈收集数据。将使用配对比较的McNemar检验、二项式逻辑回归和线性多元回归分析来检验研究假设。研究结果有可能突出将行为改变的讨论整合到癌症治疗过程中的重要性，并可能告知卫生人员和行为科学研究人员HNSCC诊断后吸烟的重要风险因素。该项目的结果也可能有助于为HNSCC患者制定更有效的戒烟干预措施。 公共卫生相关性：总的来说，这项研究很重要，因为它强调了解与减少健康风险行为相关的因素，以及临床结果的相关改善。

DESCRIPTION (provided by applicant): Behavioral research with head and neck squamous cell carcinoma (HNSCC) patients is high priority. The etiology of HNSCC is linked to the health risk behaviors of tobacco and alcohol consumption. At diagnosis, prevalence rates for cigarette smoking and alcohol use have been estimated to be above 80% and 65%, respectively. Among patients who report cigarette smoking in the year preceding diagnosis, about one-third continue to smoke following completion of cancer treatment. So while HNSCC diagnosis may be considered a "teachable moment," in which motivation for health behavior change is theorized to be high, not all patients regard HNSCC diagnosis as a sufficient catalyst for cigarette smoking cessation. Notably, this is despite the fact that continued cigarette smoking is associated with poor clinical outcomes, including poorer treatment response and higher risk for recurrence. Researchers have made attempts to identify variables associated with cigarette smoking after HNSCC diagnosis, but the current literature is limited. The overall objective of the proposed project is to increase understanding of factors facilitating and impeding smoking cessation among patients recently diagnosed with HNSCC. Specific aims: (1) To characterize the trajectory of cigarette smoking from the time of HNSCC diagnosis to 6 months following initiation of cancer treatment, (2) To assess the utility of Ajzen's Theory of Planned Behavior (TPB) for understanding changes in HNSCC patients' cigarette smoking, and (3) To assess the independent contribution of depressive symptoms and concurrent alcohol use for understanding changes in HNSCC patients' cigarette smoking. The above aims will be achieved using a prospective, longitudinal design in which 120 HNSCC patients are assessed before treatment initiation and then 2 and 6 months after treatment initiation. Males and females will be included in the study and the demographic characteristics of participants are expected to reflect the population of Kentucky. At each assessment, data will be collected via telephone interview. Study hypotheses will be tested using McNemar tests of paired comparisons, binomial logistic regression, and linear multiple regression analyses. Study results have the potential to highlight the importance of integrating discussions of behavior change into the course of cancer treatment, and may inform health personnel and behavioral science researchers of significant risk factors for cigarette smoking following HNSCC diagnosis. Results of the project may also be helpful in developing more efficacious smoking cessation interventions for HNSCC patients. PUBLIC HEALTH RELEVANCE: Overall, the proposed research is important because of its emphasis on understanding factors related to the reduction health risk behaviors, and associated improvement in clinical outcomes.