Brown R A, Ramsey S E, Strong D R, Myers M G, Kahler C W, Lejuez C W, Niaura R, Pallonen U E, Kazura A N, Goldstein M G, Abrams D B
Brown Medical School/Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA.
Tob Control. 2003 Dec;12 Suppl 4(Suppl 4):IV3-10. doi: 10.1136/tc.12.suppl_4.iv3.
To test the hypothesis that among adolescent smokers hospitalised for psychiatric and substance use disorders, motivational interviewing (MI) would lead to more and longer quit attempts, reduced smoking, and more abstinence from smoking over a 12 month follow up.
Randomised control trial of MI versus brief advice (BA) for smoking cessation, with pre- and post-intervention assessment of self efficacy and intentions to change, and smoking outcome variables assessed at one, three, six, nine, and 12 month follow ups.
A private, university affiliated psychiatric hospital in Providence, Rhode Island, USA.
Consecutive sample (n = 191) of 13-17 year olds, admitted for psychiatric hospitalisation, who smoked at least one cigarette per week for the past four weeks, had access to a telephone, and did not meet DSM-IV criteria for current psychotic disorder.
MI versus BA. MI consisted of two, 45 minute individual sessions, while BA consisted of 5-10 minutes of advice and information on how to quit smoking. Eligible participants in both conditions were offered an eight week regimen of transdermal nicotine patch upon hospital discharge.
Point prevalence abstinence, quit attempts, changes in smoking rate and longest quit attempt. Proximal outcomes included intent to change smoking behaviour (upon hospital discharge), and self efficacy for smoking cessation.
MI did not lead to better smoking outcomes compared to BA. MI was more effective than BA for increasing self efficacy regarding ability to quit smoking. A significant interaction of treatment with baseline intention to quit smoking was also found. MI was more effective than BA for adolescents with little or no intention to change their smoking, but was actually less effective for adolescents with pre-existing intention to cut down or quit smoking. However, the effects on these variables were relatively modest and only moderately related to outcome. Adolescents with comorbid substance use disorders smoked more during follow up while those with anxiety disorders smoked less and were more likely to be abstinent.
The positive effect of MI on self efficacy for quitting and the increase in intention to change in those with initially low levels of intentions suggest the benefits of such an intervention. However, the effects on these variables were relatively modest and only moderately related to outcome. The lack of overall effect of MI on smoking cessation outcomes suggests the need to further enhance and intensify this type of treatment approach for adolescent smokers with psychiatric comorbidity.
检验以下假设：在因精神疾病和物质使用障碍住院的青少年吸烟者中，动机性访谈（MI）会在12个月的随访期内带来更多且持续时间更长的戒烟尝试、减少吸烟量，并实现更多的戒烟成功。
一项关于MI与简短建议（BA）戒烟效果的随机对照试验，在干预前后评估自我效能感和改变意愿，并在1、3、6、9和12个月的随访期评估吸烟结果变量。
美国罗德岛州普罗维登斯一家私立的、与大学相关的精神病医院。
连续抽样的13至17岁青少年（n = 191），因精神病住院，在过去四周内每周至少吸一支烟，有电话可用，且不符合当前精神障碍的DSM-IV标准。
MI与BA。MI包括两次45分钟的个体辅导，而BA包括5至10分钟关于如何戒烟的建议和信息。两种情况下符合条件的参与者在出院时均提供为期八周的经皮尼古丁贴片治疗方案。
点患病率戒烟率、戒烟尝试、吸烟率变化和最长戒烟尝试时间。近端结局包括改变吸烟行为的意愿（出院时）和戒烟自我效能感。
与BA相比，MI并未带来更好的吸烟结局。MI在提高戒烟能力的自我效能感方面比BA更有效。还发现治疗与基线戒烟意愿之间存在显著交互作用。对于几乎没有或没有改变吸烟意愿的青少年，MI比BA更有效，但对于已有减少或戒烟意愿的青少年，MI实际上效果更差。然而，对这些变量的影响相对较小，且与结局仅呈中度相关。患有共病物质使用障碍的青少年在随访期间吸烟更多，而患有焦虑症的青少年吸烟较少且更有可能戒烟。
MI对戒烟自我效能感的积极影响以及对初始意愿较低者改变意愿的增强表明了这种干预的益处。然而，对这些变量的影响相对较小，且与结局仅呈中度相关。MI对戒烟结局缺乏总体影响表明需要进一步加强和强化这种针对患有精神疾病共病的青少年吸烟者的治疗方法。
