Piper Megan E, Cook Jessica W, Schlam Tanya R, Smith Stevens S, Bolt Daniel M, Collins Linda M, Mermelstein Robin, Fiore Michael C, Baker Timothy B
Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States.
Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States; William S. Middleton Memorial Veterans Hospital, United States.
Drug Alcohol Depend. 2017 Feb 1;171:50-58. doi: 10.1016/j.drugalcdep.2016.11.027. Epub 2016 Nov 24.
Understanding how smoking cessation treatments exert their effects can inform treatment development and use. Factorial designs allow researchers to examine whether multiple intervention components affect hypothesized change mechanisms, and whether the affected mechanisms are related to cessation.
This is a secondary data analysis of smokers recruited during primary care visits (N=637, 55% women, 87% white) who were motivated to quit. Participants in this fractional factorial experiment were randomized to one level of each of six intervention factors: Prequit Nicotine Patch vs None, Prequit Nicotine Gum vs None, Preparation Counseling vs None, Intensive In-Person Counseling vs Minimal, Intensive Phone Counseling vs Minimal, and 16 vs 8 Weeks of Combination Nicotine Replacement (nicotine patch+nicotine gum). Data on putative mechanisms (e.g., medication use, withdrawal, self-efficacy) and smoking status were gathered using daily assessments and during follow-up assessment calls.
Some intervention components influenced hypothesized mechanisms. Prequit Gum and Patch each reduced prequit smoking and enhanced prequit coping and self-efficacy. In-Person Counseling increased prequit motivation to quit, postquit self-efficacy, and postquit perceived intratreatment support. Withdrawal reduction and reduced prequit smoking produced the strongest effects on cessation. The significant effect of combining Prequit Gum and In-Person Counseling on 26-week abstinence was mediated by increased prequit self-efficacy.
This factorial experiment identified which putative treatment mechanisms were influenced by discrete intervention components and which mechanisms influenced cessation. Such information supports the combined use of prequit nicotine gum and intensive in-person counseling as cessation interventions that operate via increased prequit self-efficacy.
了解戒烟治疗如何发挥作用有助于治疗方法的开发与应用。析因设计使研究人员能够检验多种干预成分是否影响假设的变化机制，以及受影响的机制是否与戒烟相关。
这是一项对在初级保健就诊时招募的有戒烟意愿的吸烟者进行的二次数据分析（N = 637，55%为女性，87%为白人）。在这个分数析因实验中，参与者被随机分配到六个干预因素中每个因素的一个水平：戒烟前尼古丁贴片与无贴片、戒烟前尼古丁口香糖与无口香糖、准备咨询与无咨询、强化面对面咨询与最少咨询、强化电话咨询与最少咨询，以及16周与8周的联合尼古丁替代治疗（尼古丁贴片 + 尼古丁口香糖）。通过每日评估和随访评估电话收集关于假定机制（如药物使用、戒断反应、自我效能感）和吸烟状况的数据。
一些干预成分影响了假设的机制。戒烟前口香糖和贴片均减少了戒烟前的吸烟量，增强了戒烟前的应对能力和自我效能感。面对面咨询增加了戒烟前的戒烟动机、戒烟后的自我效能感以及戒烟后对治疗期间支持的感知。减少戒断反应和降低戒烟前吸烟量对戒烟产生的影响最为显著。戒烟前口香糖和面对面咨询相结合对26周戒烟的显著效果是通过提高戒烟前自我效能感来介导的。
这项析因实验确定了哪些假定的治疗机制受到离散干预成分的影响，以及哪些机制影响了戒烟。这些信息支持联合使用戒烟前尼古丁口香糖和强化面对面咨询作为通过提高戒烟前自我效能感起作用的戒烟干预措施。
