Siewchaisakul Pallop, Luh Dih-Ling, Chiu Sherry Y H, Yen Amy M F, Chen Chih-Dao, Chen Hsiu-Hsi
School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
Tob Induc Dis. 2020 Jul 2;18:57. doi: 10.18332/tid/123427. eCollection 2020.
The efficacy of smoking cessation intervention has been proven with randomized controlled trials. Our study aims to elucidate the effects of the delivery method of smoking cessation advice on the process of stage of changes with transtheorectical model underpinning in a community setting.
A total of 436 subjects were recruited in a quasi-experimental untreated control design study, with 46 receiving advice from healthcare professionals (HCP group) and 390 in the control group, in 2003, Nantou, Taiwan. A discrete time Markov model was used to quantify the multi-state process of smoking cessation in light of the transtheorectical model. Multiple polytomous logistic regression models were simultaneously applied to different transitions.
The estimated forward transition probabilities were higher in the HCP group compared to their counterparts in the control group. On the other hand, the backward transition probabilities were smaller in the HCP group. After adjusting for confounding factors, HCP had a 4.3-fold (95% CI: 2.21-8.46) odds ratio of moving forward from the contemplation stage, and 2.4-fold odds ratio (95% CI: 1.03-4.42) from the preparation stage. Elderly people were more reluctant to change from precontemplation (AOR=0.50; 95% CI: 0.34-0.74) and contemplation (AOR=0.58; 95% CI: 0.44-0.84), but once in the preparation stage, they were more likely to take action (AOR=1.28; 95% CI: 1.01-1.83). For those in the preparation stage, longer smoking years had a negative effect on taking action (AOR=0.74; 95% CI: 0.52-0.99), but cessation advice from others enhanced the likelihood to take action (AOR=1.36; 95% CI: 1.01-1.99).
The direct advice on smoking cessation from healthcare professionals enforced the net forward transition towards smoking cessation, especially the transition from contemplation and preparation. The proposed Markov regression model assessed the net effect of different intervention approaches allowing for the simultaneous consideration of multiple transitions and the effects of other confounders.
戒烟干预的效果已通过随机对照试验得到证实。我们的研究旨在阐明在社区环境中，以跨理论模型为基础的戒烟建议传递方式对改变阶段过程的影响。
2003年在台湾南投进行的一项准实验性无治疗对照设计研究中，共招募了436名受试者，其中46人接受医疗保健专业人员的建议（医疗保健专业人员组），390人为对照组。采用离散时间马尔可夫模型根据跨理论模型对戒烟的多状态过程进行量化。多个多分类逻辑回归模型同时应用于不同的转变。
与对照组相比，医疗保健专业人员组的估计向前转变概率更高。另一方面，医疗保健专业人员组的向后转变概率更小。在调整混杂因素后，医疗保健专业人员组从 contemplation 阶段向前转变的优势比为4.3倍（95%可信区间：2.21 - 8.46），从准备阶段向前转变的优势比为2.4倍（95%可信区间：1.03 - 4.42）。老年人更不愿意从 precontemplation（调整后优势比 = 0.50；95%可信区间：0.34 - 0.74）和 contemplation（调整后优势比 = 0.58；95%可信区间：0.44 - 0.84）阶段转变，但一旦进入准备阶段，他们更有可能采取行动（调整后优势比 = 1.28；95%可信区间：1.01 - 1.83）。对于处于准备阶段的人，吸烟年限越长对采取行动有负面影响（调整后优势比 = 0.74；95%可信区间：0.52 - 0.99），但他人的戒烟建议会增加采取行动的可能性（调整后优势比 = 1.36；95%可信区间：1.01 - 1.99）。
医疗保健专业人员提供的直接戒烟建议加强了向戒烟的净向前转变，特别是从 contemplation 和准备阶段的转变。所提出的马尔可夫回归模型评估了不同干预方法的净效应，同时考虑了多个转变以及其他混杂因素的影响。
