Mindfulness-Based Addiction Treatment Delivered Through Mobile Technology for Low-Income Smokers

项目概要/摘要 低社会经济地位（SES）的成年人经历更大的尼古丁依赖，戒烟的可能性更小 吸烟，并经历与烟草有关的健康差距。迫切需要改进 为低SES吸烟者量身定制的循证尼古丁依赖治疗。正念训练 增加戒烟率和失效恢复率，但面对面的正念治疗并不容易 低社会经济地位的吸烟者。移动的医疗技术是一种可获得的、具有成本效益的模式 提供24/7的戒烟支持。我们开发了一个短信程序（iQuit Mindfully 1.0） 提供个性化，互动的移动健康信息，以鼓励低SES吸烟者使用正念 和其他戒烟技巧在他们最需要的时候。这个程序是 根据低SES吸烟者的反复反馈设计，并作为面对面的辅助手段， 正念训练我们的试点工作表明，iQuit Mindfully 1.0是可行的，可接受的，也许 对低SES吸烟者最有效（即，23.1%的贫困参与者接受了iQuit Mindfully 在治疗结束时和1个月的随访中， 仅限个人治疗）。然而，通过全面交付该程序， 通过mHealth。本提案旨在开发、完善和评估iQuit Mindfully 2.0的可行性（即，iQuit 请注意，这是完全通过移动健康应用程序提供，以增加低SES吸烟者的可访问性）。旨在 1）使用现有的mHealth应用程序平台开发iQuit Mindfully 2.0，以提供基于正念的 专为低社会经济地位吸烟者设计的戒烟治疗; 2）完善iQuit Mindfully 2.0 基于低SES吸烟者的可用性测试; 3）评估iQuit的可行性和可接受性 正念2.0该应用程序将在对20名低SES吸烟者进行2周的初步测试后进行改进。然后，60 低SES吸烟者将被随机分配到iQuit Mindfully 2.0（n=30）或NCI QuitGuide应用程序（n=30）， 可行性试验。参与者将完成问卷测量和吸烟的生化确认 基线、8周和12周时的行为;每周评估假设的心理社会机制;以及 在12周内进行个人深入访谈。本可行性研究的预期成果是：1）参与 与应用程序和后续率; 2）参与者评级和进一步改进的建议;以及3） 记录了吸烟状况随时间推移的趋势和假设的心理社会机制。 在可行性研究之前，这项研究将为快速启动一项全面的随机临床试验奠定基础。 试验以检验疗效。如果有效的话，iQuit Mindfully应用程序可以提供更具成本效益的，可访问的 戒烟治疗（例如，通过联邦合格的健康中心免费提供， 虐待/心理健康治疗/社区中心等）针对低社会经济地位吸烟者的健康差异。

Project Summary/Abstract Adults with low socioeconomic status (SES) experience greater nicotine dependence, are less likely to quit smoking, and experience profound tobacco-related health disparities. There is an urgent need to improve upon evidence-based nicotine dependence treatments that are tailored for low-SES smokers. Mindfulness training increases rates of smoking abstinence and lapse recovery, but in-person mindfulness treatment is not easily accessible to low-SES smokers. Mobile health technology (mHealth) is an accessible, cost-effective modality for offering vital 24/7 smoking cessation support. We developed a text messaging program (iQuit Mindfully 1.0) that provides personalized, interactive mHealth messages to encourage low-SES smokers to use mindfulness and other smoking cessation techniques in the moments when they need them most. This program was designed based on iterative feedback from low-SES smokers, and serves as an adjunct to in-person mindfulness training. Our pilot work demonstrates that iQuit Mindfully 1.0 is feasible, acceptable, and perhaps most effective for low-SES smokers (i.e., 23.1% of participants living in poverty who received iQuit Mindfully achieved abstinence at end of treatment and 1-month follow-up, while none of those living in poverty quit in the in-person-only treatment). However, accessibility would be immensely improved by fully delivering the program through mHealth. This proposal aims to develop, refine and evaluate feasibility of iQuit Mindfully 2.0 (i.e., iQuit Mindfully that is fully delivered through an mHealth app to increase accessibility for low-SES smokers). Aims are: 1) Develop iQuit Mindfully 2.0 using an existing mHealth app platform to deliver mindfulness-based smoking cessation treatment that is specifically designed for low-SES smokers; 2) Refine iQuit Mindfully 2.0 based on usability testing with low-SES smokers; and 3) Evaluate the feasibility and acceptability of iQuit Mindfully 2.0. The app will be refined after 2 weeks of preliminary testing with 20 low-SES smokers. Then, 60 low-SES smokers will be randomly assigned to iQuit Mindfully 2.0 (n=30) or the NCI QuitGuide app (n=30) in a feasibility trial. Participants will complete questionnaire measures and biochemical confirmation of smoking behavior at baseline, 8, and 12 weeks; weekly assessments of hypothesized psychosocial mechanisms; and individual in-depth interviews at 12 weeks. The expected products of this feasibility study are: 1) engagement with the app and follow-up rates; 2) participant ratings and suggestions for further improvement; and 3) documented trends over time by condition in smoking status and hypothesized psychosocial mechanisms. Pending feasibility, this study would provide the groundwork for rapid launch of a full-scale randomized clinical trial to examine efficacy. If efficacious, the iQuit Mindfully app could provide more cost-effective, accessible smoking cessation treatment (e.g., offered at no cost through federally qualified health centers, substance abuse/mental health treatment/community centers, etc.) to target health disparities among low-SES smokers.