کاهش تدریجی برنامه ریزی شده کامپیوتری برای ترک دخانیات بدون دود: توسعه و ارزیابی مقدماتی از یک برنامه خودیاری
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|33868||2000||13 صفحه PDF||سفارش دهید||5385 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Computers in Human Behavior, Volume 16, Issue 5, 1 September 2000, Pages 493–505
This paper chronicles the development and feasibility testing of a computerized scheduled gradual reduction program for smokeless tobacco cessation. During Study 1, the LifeSign smoking cessation computer was adapted for use with smokeless tobacco by pairing it with an electronic timer. The computer recorded frequency of dips during a baseline phase and prompted for tobacco use during a gradual reduction phase. The timer was used to track the length of dips during baseline and to hold them to a fixed length during the reduction phase. Abstinence rates among 60 male daily smokeless tobacco users who received the program were 29% at 3-month follow-up (biochemically validated) and 19% at 12-month follow-up. Self-reported changes in topography of tobacco use were consistent with the scheduled reduction protocol. Study 2 evaluated a prototype computer that tracked both frequency and duration of dips during baseline and gradually reduced both parameters during the reduction phase. Among 19 subjects who received the program, self-reported abstinence rates were 56% at end of treatment and 11% at 12-month follow-up. Results of these two studies demonstrate the feasibility of computerized scheduled gradual reduction for smokeless tobacco cessation and provide a basis for further product development.
Use of smokeless tobacco is a growing public health concern. In the United States, more than 6% of adult men report using smokeless tobacco within the past month, and nearly 7.5 million Americans use smokeless tobacco daily (US Department of Health and Human Services, 1996). Concern over smokeless tobacco use stems from evidence that it is addictive and that long-term use is associated with a variety of diseases including cardiovascular disease, gum disease and oral cancer (see Hatsukami & Severson, 1999, for a review). Despite the popularity of smokeless tobacco and clear evidence of health risks associated with use, only a relatively small number of treatment studies have been reported. Treatment approaches have included multicomponent behavioral interventions (Dilorenzo, Kern & Pieper, 1991) and self-help manuals adopted from smoking cessation programs (Boyle and Hatsukami, 1996 and Severson et al., 2000); behavioral interventions conducted in dental office settings (Severson et al.,1998 and Stevens et al., 1995); and use of nicotine gum (Hatsukami, Jensen, Allen, Grillo & Bliss, 1996) and nicotine patches as treatment adjuncts (Howard-Pitney, Killen & Fortmann, 1999). After reviewing the available studies on smokeless tobacco cessation, Hatsukami and Severson (1999) concluded that among behavioral studies, abstinence rates at 3–6 months follow-up were typically in the 12–30% range; self-help studies and dental office interventions were promising avenues for further research; and available data do not support nicotine replacement as an effective treatment. This paper chronicles the development of an innovative self-help intervention — LifeSign for Smokeless Tobacco3 (LS-ST) — that employs a small hand-held computer (HHC) to help tobacco users quit gradually. The first reported use of HHCs for behavioral interventon was a series of studies focusing on the treatment of obesity (Agras et al., 1990 and Burnett et al., 1985). The program, referred to as CADET (computer-assisted diet and exercise treatment), adapted core components of behavioral interventions for weight loss (e.g. goal setting, self-monitoring, feedback) for implementation on an HHC. More recently, Newman and colleagues described the use of HHCs as treatment adjuncts for facilitating cognitive–behavioral therapy for anxiety disorders (Newman et al., 1999 and Newman et al., 1997). HHCs are well-suited for delivering interactive behavioral interventions in the user's environment. Treatment parameters can be adjusted dynamically in response to recorded behavior; feedback can be provided instantaneously; and self-monitored data can be stored, manipulated and displayed in numerous ways (Jerome & Frederiksen, 1992). The first use of HHCs for tobacco cessation was our work with the LifeSign smoking cessation computer (Jerome et al., 1992 and Prue et al, 1990). LifeSign for smoking cessation, as well as the current LS-ST program, uses a technique we refer to as computerized scheduled gradual reduction (CSGR). CSGR is an outgrowth of work on scheduled smoking (smoking on cue) that was explored in the early 1970s (see Cinciripini, Wetter & McClure, 1997, for a review). Early studies exploring scheduled smoking used pocket timers to deliver audible cues for smoking that were separated by either fixed or gradually increasing time intervals (Bernard & Efron, 1972 and Shapiro et al., 1971). LifeSign updated and extended this work by codifying a gradual withdrawal curve tailored to each smoker's unique baseline smoking pattern and level of within treatment compliance. A small, lightweight hardware platform, optimized for CSGR, is used to deliver the intervention. The LifeSign computer schedules cigarettes at progressively longer intervals, thereby decreasing frequency of smoking until cessation is achieved. Controlling the timing of smoking and increasing the intervals between cigarettes is presumed to have three salutary effects. First, nicotine intake is decreased gradually as fewer cigarettes are smoked. Second, social, behavioral, and psychological cues that accompany and maintain tobacco use are disrupted. Third, smokers practise coping skills required to negotiate progressively longer intervals without cigarettes. Several studies have reported positive results with the LifeSign computer (Jerome et al., 1992, Jerome et al., 1999 and Prue et al, 1990) and with reduction techniques using printed schedules for smoking cessation (Cinciripini et al., 1995 and Cinciripini et al., 1994). The LifeSign computer served as the starting point for developing LS-ST, and we modified the program to accommodate differences between smoking and smokeless tobacco use. LifeSign focuses on frequency of smoking only, because smokers exhibit little variation in the length of time required to smoke a cigarette (approximately 8 min; Kozlowski, Rickert, Robinson & Grunberg, 1980). Thus, duration is treated as a constant and is ignored in the treatment model. In contrast, smokeless tobacco users exhibit broad variability in duration of use, with reports of dip4 durations ranging from 5 min to 4 h (Hatsukami et al., 1991 and Hatsukami et al., 1988). Because of the wide variability in dip durations, the smoking cessation algorithms were inadequate for smokeless tobacco cessation, and we modified them to address both dip frequency and dip durations explicitly. The remainder of this paper focuses on two early feasibility studies that were conducted as part of our efforts to develop and validate the LS-ST program. Study 1 was the initial proof of concept study. To determine whether using CSGR for smokeless tobacco cessation was feasible, we developed a treatment program by pairing the LifeSign smoking cessation computer with a small electronic timer. For Study 2, we developed a prototype LS-ST computer that tracked and shaped both dip frequencies and durations without the need for an additional timer.