Smoking Cessation Based On TTM For Smokers In Communities Of Changsha

Objectives To introduce and formalize a series of manuals《Pathways to Change》and assessment tools for smokers and their relatives; to evaluate the effect of community-based intervention in Changsha; to explore an effective and manageable smoking cessation model for medical team especially those working in communities.Methods This was an experimental study. After the pilot study aiming to revise the manuals and tools,159 qualified smokers were selected from 6 communities of Wangyuehu, Tongzipo, Yintai, Jinxing, Yinxing, and Yingcaiyuan by random sampling. According to their different locations, the samples were divided into two groups:77 in intervention group and 82 in control group. The two manuals were given to the smokers and their relatives in intervention group after baseline. And Motivational Interviewing (MI) was carried out for the smokers in the stage of Precontemplation and Contemplation to further increase the smoking cessation motivation.4 times in assessment were carried out for smokers in two groups at baseline(V0),1 month after intervention(V1),3 months after intervention(end,V3) and follow-up (6 months after baseline,V6), respectively. The 3 following reports were completed and given to the subjectives at 7-10 days after baseline,1 month after intervention, and 2 months after intervention, respectively. The other is blank controller. After intervention 72 were obtained in intervention group and 76 in control one. In the study, the smoking situation (cigarettes per day, the times attempting to quit, smoking situation indoors and smoking cessation rate), communication with the relatives (PIQ, communicating frequency and satisfaction), and smoking cessation process (Stage, Decisional Balance, Tempting Situations and Process of Change) were evaluated for all smokers pre and post intervention. Long-term effect of the intervention on smoking situations (cigarettes per day, the times attempting to quit, and smoking cessation rate), communication with the relatives (PIQ), and smoke cessation processes (Stage, Decisional Balance, Tempting Situations and Process of Change) were further evaluated during the follow-up process.Results 1. The baseline results showed that there were 21(14.2%) mild level smokers,35 (23.6%) moderate level, and 92 (62.2%) severe levels for total 148 smokers; Logistic regressions indicated that sex, marriage, onset smoking age, and smoking indoors were the main indicators to severe levels. The total predicting accuracy was 73.0%.2. Analysis of data after intervention(1) Smoking situationsRepeated measures analysis of variance showed that main intervention effects on cigarettes per day, times attempting to quit smoking for 24h and 7d or more were significant (P<0.05), in other word, cigarettes per day, times attempting to quit smoking for 24h and 7d or more were significantly different with the change of the intervention level without taking account the change of time; the main time effects on the indicators above were significant(P<0.05); there were significant interactions between time and intervention, and interaction diagram indicated that the decrease degree of cigarettes per day and the improvement degree of times attempting to quit smoking for 24h and 7d or more were higher in intervention group than that of control group over time in the 3-month intervention.Compared the smoking situations between the intervention and control group at V0, V1, and V3, there were significant differences in Cigarettes per day, times attempting to quit smoking for 24h and 7d or more, and smoking situation indoors (P>0.05) between two groups at Vo. And all the indicators above between two groups were all significantly different at V1 and V3.Compared the cigarettes per day, times attempting to quit smoking for the smokers in intervention group at V0, V1, V3, and V6, the cigarettes per day were significantly different between those at V0 and V1,V0 and V3, but not at V1 and V3. The times attempting to quit smoking for 24h or more were all significantly different between those at V0,V1 and V3. And the times attempting to quit smoking for 7d or more were significantly different between those at V3 and V0,V3 and V1, but not at V0 and V1. Follow-up at V6 showed the cigarettes per day and the times attempting to quit smoking for 7d or more at V6 were significantly different from those at V0 and V1, but not at V3. The times attempting to quit smoking for 24h or more at V6 were all significantly different from those at V0, V1,V3. The trend of change indicated that the cigarettes per day decreased and the times attempting to quit smoking increased with time.(2) Communication with the relativesRepeated measures analysis of variance showed that main intervention effects on the Negative and Positive of PIQ were significant (P<0.05), in other words, scores of the Negative and Positive of PIQ were significantly different with the change of the intervention level without taking account the change of time; the main time effects on the Negative were not significant (P>0.05), and there were not significant interactions between time and intervention (P>0.05); the main time effects on the Positive were significant (P<0.05), and there were significant interactions between time and intervention (P<0.05); interaction diagram indicated that the improvement degree of the Positive of PIQ were higher in intervention group than that of control group over time in the 3-month intervention.Compared the communication with the relatives between the intervention and control group at V0, V1, and V3, there were significant differences in the scores of the Negative and Positive of PIQ, communicating frequency and satisfaction between two groups at V0(P>0.05). And all the indicators above between two groups are significantly different at V1 (P<0.05). But at V3 the Negative between two groups are not significantly different (P>0.05), and the Positive, communicating frequency and satisfaction were significantly different (P<0.05).Compared the Negative and Positive of PIQ for the smokers in intervention group at V0, V1, V3 and V6, the Positive were significantly different between those at V0 and V1,V0 and V3, but not at V1 and V3. And the Negative were all not significantly different between those at V0,V1 and V3. Follow-up at V6 showed the Negative were all significantly different. The Positive at V6 were significantly different from those at V0, but not at V1 and V3.(3) Smoking cessation processRepeated measures analysis of variance showed that main intervention effects on the Decisional Balance, Tempting Situations and Process of Change were significant (P<0.05), in other words, scores of the Decisional Balance, Tempting Situations and Process of Change were significantly different with the change of the intervention level without taking account the change of time; the main time effects on all the indicators above were significant (P<0.05), and there were significant interactions between time and intervention (P<0.05); the decrease degree of Pros and Tempting Situations, and the improvement degree of Cons, the Experiential Processes and Behavioral Processes were higher in intervention group than that of control group over time in the 3-month intervention.Compared the smoking cessation process between the intervention and control group at V0, V1, and V3, there were significant differences in the Stages, Pros and Cons, Tempting Situations, Experiential Processes and Behavioral Processes between two groups at V0(P>0.05). And all the indicators above except Tempting Situations between two groups are significantly different at V1 (P<0.05). At V3 all the indicators above between two groups were significantly different (P<0.05). Also the quit rate of smokers in intervention group at V1 and V3 were 12.5%,23.6% respectively, which were 2.6% and 1.3% in control group. The rates were significantly different between the two groups at V1 and V3 (P<0.05).Compared the smoking cessation process for the smokers in intervention group at Vo, V1, V3 and V6, Pros and Cons, and Behavioral Processes, the quit rate were significantly different between those at Vo and V1,V0 and V3, but not at V1 and V3. And Tempting Situations were significantly different between those at V3 and V0,V3 and V1, but not at V1 and V0. Experiential Processes were all significantly different between those at V0,V1 and V3. Follow-up at V6 showed the Pros and Cons, Tempting Situations, and Behavioral Processes at V6 were all significantly different from those at V0, V1,and V3. The Experiential Processes at V6 was significantly different from those at V0 and V1, but not at V3. The Stages were all significantly different at V6, V0, V1, and V3.The quit rate at V6 was 20.8%, which was significant different from that at V0, but not at V1,and V3.(4) The forecasting model of quitting smoking successfully or not after interventionModelled the generalized estimating equations based on the longitudinal data, the results showed that sex and the Negative of PIQ were not significantly different in quitting smoking or not. There existed positive correlation between quitting smoking or not and the point-in-time, the positive of PIQ, age, degree of education, times attempting to quit smoking for 7d or more, goals about smoking(P<0.05), but it was negative in drinking. And there were significant differences between two groups in quitting smoking successfully after intervention (P<0.05).3. the relationship among the Stage and PIQ, Pros, Cons, Tempting Situations, Experiential Processes and Behavioral ProcessesThe Negative and Positive of PIQ, Pros, Cons, Tempting Situations, Experiential Processes and Behavioral Processes were changing with the development of the Stages.Conclusion 1.The rate of smokers in severe level is high, and sex, marriage, onset smoking age, and smoking indoors are significantly related to the level.2. The intervention reduced the cigarettes per day, increased the times attempting to quit smoking, improved the smoking situation indoors; improved the communication between smokers and there supporters, increased the communicating frequencies and satisfaction; advanced the stages and increased the quit rate; improved the Pros and Cons; reduced the Tempting Situations; increased Experiential Processes and Behavioral Processes;3. The variationof the Pros, Cons, Tempting Situations, Experiential Processes and Behavioral Processes could lead to the change of Stages. And the scores of PIQ in different stages were not the same.