Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Psychology and Behavior Analysis, Universidade Estadual de Londrina, Londrina, Paraná, Brazil.
J Womens Health (Larchmt). 2022 Nov;31(11):1620-1629. doi: 10.1089/jwh.2021.0443. Epub 2022 May 17.
There is scarcity of smoking cessation programs that take gender into account during its development, implementation, and evaluation. We evaluated the efficacy of a theory-based, culturally, and gender-relevant smoking cessation intervention delivered by Community Health Workers (CHWs) among Brazilian women that augments the smoking cessation program offered through the public health system (PHS). A total of 328 women current smokers (100% cigarette smokers) were recruited across 8 towns in a tobacco producing state in Brazil between 2014 and 2017. Four towns were randomly assigned to the intervention (12 home visits by a CHW and a scheduled appointment to attend the smoking cessation program at the PHS) and four towns to the control condition (scheduled appointment to attend the cessation program at the PHS). The primary outcome was self-reported 7-day smoked tobacco abstinence at 7-month follow-up with biochemical verification. Retention at 7-month follow-up was 80.7% (intervention) and 85.1% (control). Using intention-to-treat analysis, abstinence at 7-month-follow-up was 20% in the intervention arm versus 11% in the control arm. Multivariable modeling showed that participants in the intervention arm had 1.88 times the odds of self-reported smoking cessation than control participants after adjustment for depressive symptomatology, self-efficacy, and having someone in the house who smokes. Besides the intervention, only self-efficacy remained significant in the full model as a predictor of cessation. Replication of these analyses using the objective measure of carbon monoxide at a cutoff score of 8 ppm yielded similar results. A theory-based, culturally, and gender-relevant intervention, delivered by CHWs, can successfully promote smoking cessation among women. Clinical Trial Registration No. NCT03845413.
在制定、实施和评估过程中，很少有考虑到性别的戒烟项目。我们评估了一种基于理论、具有文化相关性和性别相关性的戒烟干预措施的效果，该干预措施由社区卫生工作者（CHWs）提供，旨在增强公共卫生系统（PHS）提供的戒烟计划。在巴西一个产烟州的 8 个城镇，我们在 2014 年至 2017 年期间共招募了 328 名当前吸烟的女性（100%为香烟吸烟者）。其中 4 个城镇被随机分配到干预组（由 CHW 进行 12 次家访，并安排预约参加 PHS 的戒烟计划），4 个城镇被分配到对照组（安排预约参加 PHS 的戒烟计划）。主要结局是在 7 个月随访时通过生化验证报告的 7 天吸烟烟草戒断情况。7 个月随访时的保留率为干预组 80.7%（干预组）和对照组 85.1%（对照组）。采用意向治疗分析，干预组在 7 个月随访时的戒烟率为 20%，对照组为 11%。多变量模型显示，在调整抑郁症状、自我效能和家中有人吸烟后，干预组参与者自我报告的戒烟可能性是对照组参与者的 1.88 倍。除了干预措施外，只有自我效能在完全模型中仍然是戒烟的重要预测因素。使用碳 monoxide 的客观测量值（截断分数为 8 ppm）进行这些分析的复制也得到了类似的结果。由 CHWs 提供的基于理论、具有文化相关性和性别相关性的干预措施可以成功地促进女性戒烟。临床试验注册号 NCT03845413。
