Withdrawal Trajectory Predictors of Smoking Relapse

戒烟轨迹预测复吸的因素

• 批准号: 10303726
• 负责人: DAVID G GILBERT
• 金额: $ 7.83万
• 依托单位: SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10303726
• 关键词: Abstinence; Affect; Affective; Biochemical; Clinical; Cognitive; Collaborations; Data; Data Analyses; Exclusion; Funding; Goals; Growth; Incentives; Individual; Intervention; Lead; Logistic Regressions; Measures; Moods; National Institute of Drug Abuse; Outcome; Patients; Pharmacology; Procedures; Public Health; Recovery; Refractory; Relapse; Resolution; Risk; Sampling; Severities; Smoker; Smoking; Time; Tobacco Dependence; Withdrawal; Withdrawal Symptom; base; clinical practice; clinically significant; cognitive function; cost; craving; follow-up; high risk; improved; negative affect; open data; prevent; psychosocial; relapse prediction; relapse risk; smoking abstinence; smoking cessation; smoking relapse; study population

By analyzing the results from four completed NIDA-funded studies, the major goal of this revised R03 proposal is to assess whether long-term smoking relapse is predicted by decreases in positive affect (PA) and cognitive functioning (CF) and by slow recovery of PA and CF during the first days and month of smoking abstinence in those who maintain abstinence for at least 31 days. A second study goal is to replicate findings (Zuo et al., 2017) that slow dissipation of negative affect (NA) during the first days of abstinence predicts both short- and long-term relapse to smoking. The third goal of the study is to use data from the four studies to generate a clinically useful risk-for-relapse scale (Short Cognitive-Affective Relapse Risk Scale [SCARRS]) based on the most predictive withdrawal-symptom items from the studies. While NA was assessed as a predictor of relapse in the Zuo et al. study, PA and CF were collected but not assessed as potential predictors in any of the four studies, each of which assessed smoking withdrawal symptom (SWS) trajectories for a minimum of 31 days of incentivized, biochemically verified smoking abstinence, and collected relapse information at 3, 6, 9, and 12 months. An advantage of assessing these relationships in studies that provided incentives for maintaining abstinence during the first 31+ days is that individuals who normally would have relapsed and therefore not have been included in the assessed sample are maintained in the abstinent state, something that avoids the problem of those with the most severe SWSs relapsing and not being included in the study population. Exclusion of such individuals typically results in underestimates of SWS severity and duration and minimizes the ability to assess the relationship of SWS to relapse in those who maintain initial abstinence. In addition, a sizable portion of smokers relapse after 31+ days. If slow dissipation of NA and/or slow recovery of PA and/or CF during early abstinence are found to predict a persistent risk for later relapse, these variables may be valid targets for interventions to increase long-term cessation in individuals with refractory SWSs. To facilitate clinical adaptation, we will generate a brief SWS predictor of risks for relapse based on the statistical identification of items that most effectively predict relapse from the standard lengthier measures of SWSs used in the four studies. To probe the earliest time window for individualized intervention, we will assess whether the rate of dissipation of SWSs across days 3 through 31 of abstinence can be established as markers of significance for relapse; and specifically, whether greater increases in SWSs from baseline to the third day of abstinence, slower resolution of these SWSs from day 3 to day 6 and to day 12 and 31 of abstinence are each predictive of relapse, even after controlling for craving. Growth curve and logistic regression analyses for data combined across the studies will be used to assess associations of an individual’s SWS trajectory parameters and craving with the abstinence outcomes at 3-month and 1-year postquit. A finding that the very brief (e.g., 12-20 item) SCARRS can identify individuals at high risk for relapse could lead to its widespread clinical use.

通过分析 NIDA 资助的四项已完成研究的结果，修订后的 R03 提案的主要目标 旨在评估是否可以通过积极情绪（PA）的减少来预测长期吸烟复吸，以及 认知功能 (CF) 以及在吸烟的最初几天和一个月内 PA 和 CF 缓慢恢复 禁欲至少 31 天的人。第二个研究目标是复制研究结果 （Zuo 等人，2017）在禁欲的第一天，负面情绪 (NA) 的缓慢消散预示着这两种情况 短期和长期吸烟复发。该研究的第三个目标是利用四项研究的数据 生成临床上有用的复发风险量表（短认知情感复发风险量表 [SCARRS]） 基于研究中最具预测性的戒断症状项目。虽然 NA 被评估为 Zuo 等人中复发的预测因子。研究中收集了 PA 和 CF，但未将其作为潜在的预测因子进行评估 在这四项研究中的任何一项中，每项研究都评估了戒烟症状（SWS）的轨迹 至少 31 天的激励、生化验证的戒烟，并收集复发情况 3、6、9 和 12 个月的信息。在提供的研究中评估这些关系的优点 在前 31 天以上保持禁欲的动机是，那些通常会 复发且因此未被纳入评估样本的人保持戒断状态， 避免那些患有最严重 SWS 的人复发并且不被包括在其中的问题 研究人群。排除这些人通常会导致低估 SWS 的严重性和持续时间 并最大限度地降低评估 SWS 与维持最初戒断的患者复发之间关系的能力。 此外，相当一部分吸烟者在 31 天以上后复吸。如果 NA 消散缓慢和/或恢复缓慢 研究发现，早期戒断期间 PA 和/或 CF 的发生可预测后期复发的持续风险，这些变量 可能是增加难治性 SWS 个体长期戒烟干预措施的有效目标。到 促进临床适应，我们将根据统计数据生成一个简短的 SWS 复发风险预测因子 从所使用的标准较长 SWS 测量中确定最有效预测复发的项目 在四项研究中。为了探讨个体化干预的最早时间窗口，我们将评估是否 禁欲第 3 天到第 31 天的 SWS 消散率可以作为戒断的标志。 对复发的意义；具体来说，从基线到治疗第三天，SWS 是否有更大的增加？ 禁欲后，从禁欲第 3 天到第 6 天以及第 12 天和第 31 天，这些 SWS 的解决速度较慢 即使在控制了渴望之后，也可以预测复发。数据的增长曲线和逻辑回归分析 综合所有研究将用于评估个人 SWS 轨迹参数的关联 以及渴望戒烟后 3 个月和 1 年后的戒断结果。一个非常简短的发现（例如， 12-20 项）SCARRS 可以识别复发高风险个体，这可能导致其广泛的临床应用。