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Objective To describe a tobacco cessation intervention using personalized mobile phone text messages based on behaviour change theory and to assess why the intervention was effective. Methods We conducted a two-arm, double-blind, randomized controlled trial in five cities in China from April to July 2021. We recruited daily or weekly smokers aged 18 years or older. The 90-day intervention was delivered using a mobile phone chat application. At different stages of quitting, intervention group participants received personalized text messages based on analyses of the strength of their intention to quit, their motivation to quit and their self-reported success at quitting. Control group participants received non-personalized text messages. The primary outcome was the biochemically verified 6-month abstinence rate. Secondary outcomes were changes in scores on the components of protection motivation theory. All analyses were by intention to treat. Findings We randomly assigned 722 participants to intervention or control groups. Biochemically verified continuous abstinence at 6 months was 6.9% (25/360) in the intervention group and 3.0% (11/362) in the control group. Smokers who received the personalized intervention had lower scores on intrinsic rewards of smoking and response costs of quitting in the protection motivation theory analysis. These two variables were also determinants of sustained abstinence, thus explaining why the intervention group had a higher quitting rate. Conclusion The study confirmed the psychological determinants of long-term abstinence from smoking and provided a framework to explore why such an intervention is effective. This approach may be applicable to the development or analysis of interventions targeting other health behaviours. Objectif Presenter une intervention de sevrage tabagique articulee autour de messages SMS envoyes sur les telephones mobiles et personnalises en fonction de la theorie du changement de comportement, puis determiner pourquoi cette intervention a porte ses fruits. Methodes Nous avons mene un essai controle randomise en double aveugle et a deux volets dans cinq villes de Chine entre avril et juillet 2021. Nous avons recrute des fumeurs quotidiens ou hebdomadaires ages de 18 ans et plus. L'intervention, qui s'etalait sur 90 jours, s'est deroulee par l'intermediaire d'une application de chat sur telephone mobile. A differents stades du sevrage, les participants du groupe d'intervention ont recu des messages SMS personnalises bases sur une analyse de leur degre de volonte et de leur motivation a arreter de fumer, mais aussi de leurs capacites autodeclarees a y parvenir. De leur cote, les participants du groupe de controle ont recu des messages SMS non personnalises. Le taux d'abstinence a six mois verifie par test biochimique constituait le critere d'evaluation principal. Les criteres d'evaluation secondaires etaient l'evolution des scores au niveau des composantes de la theorie de la motivation a la protection. Toutes les analyses reposaient sur l'intention de traiter. Resultats Nous avons reparti aleatoirement 722 participants entre groupes d'intervention et de controle. Le taux d'abstinence a six mois verifie par test biochimique s'elevait a 6,9% (25/360) au sein du groupe d'intervention et a 3,0% (11/362) au sein du groupe de controle. Dans le cadre de l'analyse fondee sur la theorie de la motivation a la protection, les fumeurs ayant fait l'objet d'une action personnalisee ont obtenu des scores plus faibles en matiere de recompense intrinseque provoquee par le tabagisme et de couts d'intervention du sevrage. Ces deux variables se sont egalement revelees decisives dans l'abstinence prolongee, ce qui explique pourquoi le groupe d'intervention a affiche un taux de sevrage plus consequent. Conclusion L'etude a confirme l'impact des determinants psychologiques de l'abstinence a long terme et fourni des pistes d'exploration des raisons pour lesquelles une telle action est efficace. Cette approche pourrait etre utilisee dans le developpement ou l'analyse d'interventions ciblant d'autres comportements lies a la sante. Objetivo Describir una intervencion para dejar de fumar mediante el uso de mensajes de texto personalizados para telefonos moviles basada en la teoria del cambio de conducta y evaluar por que la intervencion fue eficaz. Metodos Se realizo un ensayo aleatorizado, con enmascaramiento doble y con dos grupos en cinco ciudades de China entre abril y julio de 2021. Se preseleccionaron fumadores diarios o semanales mayores de 18 anos. La intervencion de 90 dias se realizo mediante una aplicacion de chat para telefonos moviles. En las diferentes etapas de abstinencia, los participantes del grupo de intervencion recibieron mensajes de texto personalizados segun los analisis de la fuerza de su intencion de dejar de fumar, su motivacion para dejar de fumar y su exito autoinformado al dejar de fumar. Los participantes del grupo comparativo recibieron mensajes de texto no personalizados. El criterio de valoracion principal fue la tasa de abstinencia verificada mediante pruebas bioquimicas a los 6 meses. Los criterios de valoracion secundarios fueron los cambios en las puntuaciones de los componentes de la teoria de la motivacion de proteccion. Todos los analisis se realizaron por intencion de tratar. Resultados Se asignaron aleatoriamente 722 participantes a los grupos de intervencion o comparativos. La abstinencia continua verificada mediante pruebas bioquimicas a los 6 meses fue del 6,9% (25/360) en el grupo de intervencion y del 3,0% (11/362) en el grupo comparativo. Los fumadores que recibieron la intervencion personalizada tuvieron puntuaciones mas bajas en las recompensas intrinsecas de fumar y en los costes de respuesta de dejar de fumar en el analisis de la teoria de la motivacion de proteccion. Estas dos variables tambien fueron determinantes de la abstinencia prolongada, lo que explica por que el grupo de intervencion tuvo una tasa de abstinencia mas elevada. Conclusion El estudio confirmo los determinantes psicologicos de la abstinencia del tabaco a largo plazo y proporciono un marco para explorar por que una intervencion de este tipo es eficaz. Este enfoque podria aplicarse al desarrollo o analisis de intervenciones dirigidas a otros habitos saludables., Introduction Tobacco use is still a major public health problem worldwide. The most common type of tobacco use is cigarette smoking, which is one of the leading preventable causes of [...]

Background The needs of outpatient services, a key accessible health resource, are increasing in an increasingly aging population in China. So rational allocation of outpatient service resources to meet older people's health needs is a key to improving their health level. Objective To explore the factors affecting the utilization of outpatient services in the elderly, to provide feasible suggestions for improving older people's health level and the allocation of medical resources. Methods This study was conducted in 2021 using the data of older people (≥60 years old) attending the CHARLS 2018. The number of using outpatient services in these people in the past month prior to the CHARLS 2018 and associated factors were studied using a system developed based on the framework of Anderson's Behavioral Model of Health Services Use, with sex, age, marital status, the type of hukou (rural or urban), education level, smoking and drinking were classified as predisposing factors, health insurance, monthly household income per capita and the average distance from home to medical institutions as enabling factors, and chronic disease prevalence and self-rated health as need factors. The zero-inflated negative binomial regression (ZINB) was used to identify factors associated with the use of outpatient services. Results In all, 9 551 older people were included for analysis. Among them, non-users of outpatient services in the past month numbered 8 038 (84.16%), and one-time, two-time, and three or more-time users numbered 749 (7.84%), 367 (3.84%), and 397 (4.16%), respectively. The number of using outpatient services differed statistically by the type of hukou, education level, smoking, drinking, health insurance prevalence, monthly household income per capita, chronic disease prevalence, and self-rated health status (P