Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, 88 Wakefield St, Adelaide, SA, 8000, Australia.
College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
Addict Sci Clin Pract. 2023 Feb 6;18(1):7. doi: 10.1186/s13722-022-00355-w.
Smoking and resulting health problems disproportionately impact low socioeconomic status (SES) individuals. Building resilience presents an approach to 'closing the gap'. Mindfulness-based interventions and setting realistic goals are preferred in low socioeconomic communities. We aim to test if these interventions, delivered online and consolidated with peer support offered via ex-smokers, are successful in promoting smoking cessation and resilience. Our conceptualisation of resilience encompasses the inner capacity/skills and external resources (e.g., social support) which smokers utilise to bounce back from adversity. We include a process evaluation of barriers/facilitators to interventions and cost-effectiveness analysis (from health system perspective).
We plan a four-arm parallel 12-month RCT with a 6-month follow-up to test the efficacy of three group-based interventions each followed by peer support. Arm 1: mindfulness-integrated cognitive behavioural therapy; Arm 2: mindfulness training; Arm 3: setting realistic goals; Arm 4: active control group directed to quit services. All interventions will be administered online. Participants are adult smokers in Australia (N = 812) who have an average weekly household income less than $457AUD or receive welfare benefits. Group-based interventions will occur over 6 months, followed by 6 months of forum-based peer support.
self-reported 14-day period prevalence of smoking abstinence at 6 months, with remote biochemical verification of saliva cotinine (< 30 ng/mL). Secondary outcomes include: internal resilience (Connor-Davidson Resilience Scale-25); external resilience (ENRICHD social support tool); quality adjusted life years (EQ-5D-5L); self-efficacy for smoking abstinence (Smoking-Abstinence Self-Efficacy Questionnaire); motivation to quit smoking (Biener and Abrams Contemplation Ladder); nicotine dependence (Fagerstrom Test for Nicotine Dependency); equanimity (Equanimity Scale-16); stress (Perceived Stress Scale-10); goal assessment/attainment (Problems and Goals Assessment Scale).
This study is the first to compare resilience interventions for low SES smokers which have been identified by them as acceptable. Our various repeated measures and process evaluation will facilitate exploration of mechanisms of impact. We intervene within the novel framework of the Psychosocial Model of Resilience, applying a promising paradigm to address a critical and inequitable public health problem. Trial registration Australian New Zealand Clinical Trials Registry ID: ACTRN12621000445875, registered 19 April 2021 ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381007&isReview=true ). The Universal Trial Number is U1111-1261-8951.
吸烟和由此产生的健康问题不成比例地影响社会经济地位较低（SES）的个人。建立韧性是一种“缩小差距”的方法。在社会经济地位较低的社区，基于正念的干预措施和设定现实目标是首选。我们旨在测试这些干预措施是否有效，这些干预措施通过在线提供，并通过前吸烟者提供的同伴支持进行整合，以促进戒烟和增强韧性。我们对韧性的概念包括吸烟者用来从逆境中恢复的内在能力/技能和外部资源（例如社会支持）。我们包括对干预措施的障碍/促进因素的过程评估和成本效益分析（从卫生系统角度）。
我们计划进行一项为期 12 个月的四臂平行 RCT，随访 6 个月，以测试三种基于小组的干预措施的疗效，每种干预措施都伴有同伴支持。第 1 组：正念整合认知行为疗法；第 2 组：正念训练；第 3 组：设定现实目标；第 4 组：积极对照组，指导戒烟服务。所有干预措施将在线进行。参与者是澳大利亚的成年吸烟者（N=812），他们的平均周家庭收入低于 457 澳元或领取福利。小组干预将持续 6 个月，然后是 6 个月的基于论坛的同伴支持。
6 个月时自我报告的 14 天吸烟戒断期患病率，唾液可替宁的远程生物化学验证（<30ng/mL）。次要结果包括：内在韧性（Connor-Davidson 韧性量表-25）；外在韧性（ENRICHD 社会支持工具）；质量调整生命年（EQ-5D-5L）；戒烟自我效能感（戒烟自我效能感问卷）；戒烟动机（Biener 和 Abrams 沉思阶梯）；尼古丁依赖（尼古丁依赖测试）；平静（平静量表-16）；压力（感知压力量表-10）；目标评估/实现（问题和目标评估量表）。
这是第一项比较社会经济地位较低的吸烟者的韧性干预措施的研究，这些干预措施已被他们认为是可接受的。我们的各种重复测量和过程评估将有助于探索影响机制。我们在韧性的心理社会模型的新框架内进行干预，应用有前途的范式来解决一个关键且不平等的公共卫生问题。试验注册澳大利亚新西兰临床试验注册中心 ID：ACTRN12621000445875，注册于 2021 年 4 月 19 日（https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381007&isReview=true）。通用试验编号为 U1111-1261-8951。
