Taniguchi Chie, Narisada Akihiko, Ando Hirohiko, Hashimoto Akane, Nakayama Ayako, Ito Masaki, Tanaka Hideo, Suzuki Kohta
College of Nursing, Aichi Medical University, Nagakute, Japan.
Institute for Occupational Health Science, Aichi Medical University, Nagakute, Japan.
Tob Induc Dis. 2023 Oct 6;21:125. doi: 10.18332/tid/170430. eCollection 2023.
The Health Belief Model comprises two constructs influencing changed behaviors impacting on health, namely perceived severity and susceptibility. The aim of this study was to identify the impact of the combination of, or interactions between, these two constructs on quitting smoking in smokers with a diagnosis of a non-communicable disease (NCD).
From the large insurance claims database maintained by JMDC database (JMDC, Tokyo), we extracted data on 13284 participants who smoked. All participants were stratified according to their NCD diagnosis based on perceived severity and susceptibility as follows: Category I (high severity and high susceptibility) - acute myocardial infarction, and lung cancer; Category II (high severity and low susceptibility) - colorectal cancer, and stomach cancer; Category III (low severity and high susceptibility) - asthma, and transient ischemic attack; Category IV (low severity and low susceptibility) - appendicitis, and glaucoma. We performed multi-variable logistic regression analysis and calculated the proportion of those who were smoking at the first health check-up after the diagnosis and every three years thereafter.
Using glaucoma as the reference, the adjusted odds ratios for smoking cessation were 14.2 (95% CI: 11.4-17.8) to 14.8 (95% CI: 12.5-17.4) in Category I; 4.5 (95% CI: 3.8-5.4) to 6.6 (95% CI: 5.4-8.0) in Category II; and 1.9 (95% CI: 1.7-2.1) to 2.8 (95% CI: 2.2-3.7) in Category III. In Categories I and II, the proportion of smokers rapidly decreased after diagnosis and mostly remained low thereafter. Smoking cessation rates for Categories I and II were not associated with readiness to improve lifestyles prior to NCD diagnosis.
Our study confirms the significant impact of perceived severity of and susceptibility to the diagnosed disease on smoking cessation. The multiplicative effect of these two constructs at NCD diagnosis represents a 'teachable moment', a window of opportunity, for encouraging successful long-term smoking cessation.
健康信念模型包含两个影响健康相关行为改变的要素，即感知严重性和易感性。本研究旨在确定这两个要素的组合或相互作用对诊断为非传染性疾病（NCD）的吸烟者戒烟的影响。
从JMDC数据库（东京JMDC）维护的大型保险理赔数据库中，我们提取了13284名吸烟者的数据。所有参与者根据其基于感知严重性和易感性的非传染性疾病诊断进行分层，如下：第一类（高严重性和高易感性）——急性心肌梗死和肺癌；第二类（高严重性和低易感性）——结直肠癌和胃癌；第三类（低严重性和高易感性）——哮喘和短暂性脑缺血发作；第四类（低严重性和低易感性）——阑尾炎和青光眼。我们进行了多变量逻辑回归分析，并计算了诊断后首次健康检查时以及此后每三年仍在吸烟的人群比例。
以青光眼为参照，第一类人群戒烟的调整优势比为14.2（95%置信区间：11.4 - 17.8）至14.8（95%置信区间：12.5 - 17.4）；第二类为4.5（95%置信区间：3.8 - 5.4）至6.6（95%置信区间：5.4 - 8.0）；第三类为1.9（95%置信区间：1.7 - 2.1）至2.8（95%置信区间：2.2 - 3.7）。在第一类和第二类中，吸烟者比例在诊断后迅速下降，此后大多保持在较低水平。第一类和第二类的戒烟率与非传染性疾病诊断前改善生活方式的意愿无关。
我们的研究证实了对已诊断疾病的感知严重性和易感性对戒烟有显著影响。这两个要素在非传染性疾病诊断时的相乘效应代表了一个“可教时刻”，即一个鼓励成功长期戒烟的机会窗口。
